We describe a 9-year-old white boy with systemic juvenile rheumatoid a
rthritis (JRA) who developed pancytopenia and hypersplenism at the age
of 13 years. He underwent splenectomy and 3 years later he developed
Coombs' positive hemolytic anemia, alopecia, juvenile warts, and multi
ple bacterial infections. At that time, investigations were compatible
with severe hypogammaglobulinemia associated with common variable imm
unodeficiency. Concomitantly with this condition he experienced comple
te remission of his inflammatory arthritis. Immunologic studies of B a
nd T lymphocyte function showed that the number of circulating T and B
lymphocytes were normal, while T cell function was depressed, as evid
enced by markedly reduced proliferative responses to mitogens and anti
gens, and ability to mediate B cell help. In addition, his circulating
B cells were unable to secrete IgM or IgG. He also exhibited anergy t
o intradermal challenge with a battery of common antigens. The literat
ure dealing with this clinical association is reviewed, and possible i
mmunologic mechanisms involved are discussed.