Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: In their article about antithymocyte
globulin and cyclosporine for severe aplastic anemia, Dr Rosenfeld and colleagues1 did not discuss Good and colleagues'2 1956
description of an associated syndrome of gammaglobulinemia, presumably due
to immune suppression, in patients with benign thymic tumors. In our clinical
experience, we have found that this syndrome can be associated with severe
aplastic anemia and vitiligo. Although these findings do not necessarily respond
to intravenous γ globulin or antithymocyte globulin, we have found that
cyclosporine may lead to a dramatic response. Rosenfeld et al, however, did
not indicate whether their patients had signs of immunosuppression, such as
hypogammaglobulinemia, hypothyroidism, pernicious anemia, or vitiligo.
Nagy, Jr SM, Fisher JJ. Aplastic Anemia and Immunosuppression—Reply. JAMA. 2003;290(2):193. doi:10.1001/jama.290.2.193-a