REINFECTION WITH CHLAMYDIA-PNEUMONIAE MAY INDUCE ISOLATED AND SYSTEMIC VASCULITIS IN SMALL AND LARGE VESSELS

It is a common clinical experience that the onset of the so called non infectious vasculitides is often preceded by upper respiratory tract symptoms. A specific agent is only occasionally recovered. We report f ive cases in Sweden with manifestations of vasculitis from different o rgans. In three of the five patients the onset was preceded by upper r espiratory tract symptoms. All patients had serologic findings indicat ing Chlamydia pneumoniae infection and all required corticosteroid tre atment for symptomatic recovery. One was diagnosed as an aseptic menin gitis. Another was diagnosed as a cerebral arteritis, probably a varia nt of a giant cell arteritis. A third patient had symptoms similar to a polymyalgia rheumatica engaging the thighs. Two patients had an acut e myocardial infarction. One of them had Cogan's syndrome. The other a lso had pulmonary and hepatic engagement and an elevated level of anti basement membrane IgM antibodies, though not to the Goodpasture antig en. He had no renal involvement. The diagnosis of Chlamydia pneumoniae infection was based on the detection of species-specific IgA, IgG and IgM antibodies to Chlamydia pneumoniae using microimmunofluorescence technique, MIF. Four of the 5 cases exhibited a fourfold increase in a ntibody titers, and the fifth case was found to have high levels of Ig G and IgA antibodies, suggesting recent infection. Investigations for other infectious agents were negative in all patients. The serologic f indings in those patients are consistent with a pattern of reinfection with Chlamydia pneumoniae. We therefore suggest that reinfection with Chlamydia pneumoniae may induce isolated and systemic vasculitis in v irtually any organ of the body.