Immunoelectrophoretic tailing albumin phenomenon. Associations with clinical characteristics of the patients and with nitrofurantoin treatment.

Abstract

The study is a retrospective analysis of the clinical features of 122 patients from Finland, whose serum showed in immunoelectrophoresis (IEP) a cathodic elongation of the albumin line, "tailing albumin" (TA), not associated with an M-component. One hundred and seventeen of these cases were found among about 40,000 consecutive routine serum IEP examinations in two laboratories during 1967-1980. Five further cases were detected during the collection of the control series. Only a few TA cases of corresponding type have been reported from elsewhere. Previous studies of some of the patients of the present series had shown that the TA phenomenon was due to complexes between albumin and IgG class autoantibodies against albumin. Clinical data were collected mainly from the hospital records. The chest radiographic findings were classified by the ILO (International Labour Office) method. The author herself examined 33 of the patients during the current disease or during the follow-up. One hundred and ten patients were followed up for a period of three months to nine years (mean 2.5 years). The patients were mostly elderly, and 93% of them were women. Most of the patients had one or more previously diagnosed chronic illnesses, for which they were receiving one or several drugs as long-term therapy. Eighty percent of the patients were receiving nitrofurantoin (NF) as prophylaxis for recurrent urinary tract infections. However, urinary tract infection was not a current problem in any of the cases. There was evidence of a role of NF in the development of both the immunologic abnormalities and the clinical disease in the TA patients. On the basis of long-term NF treatment the patients were divided into two groups: 1) 97 patients with NF therapy (NF+ group) and 2) 25 patients without NF therapy (NF- group). The patients had mostly undergone the examinations because of cough, dyspnoea, and general symptoms (fatigue, weakness, malaise, loss of weight). The symptoms had usually started insidiously, and in 50% of the patients they had lasted for at least three months. Eight of the patients had been hospitalized because of various acute diseases (e.g. cerebral stroke). Ten of the patients were subjectively symptomless. The most common pathologic laboratory findings were high erythrocyte sedimentation rate (over 100 mm/h in 47%), IgG class antinuclear antibodies (in 88%; the titre was greater than or equal to 1000 in 56%), high serum IgG (mean 30.6 g/l), and elevated levels of serum aminotransferases (in 54% of the patients examined).(ABSTRACT TRUNCATED AT 400 WORDS)