LETTERS TO THE EDITOR
Vol. 68 • No. I PAUL G. HATTERSLEY,
M.D.
Departments of Internal Medicine and Pathology Sacramento Medical Center 2315 Stockton Blvd. Sacramento, California 95817
References 1. Branson HE, Wyatt LL, Schmer G: Complement consumption in acute disseminated coagulation without antecedent immunopathology. Am J Clin Pathol 66:967-975, 1976 2. Hattersley P: Activated coagulation time of whole blood. JAMA 196:
95 436-440, 1966 3. Hattersley PG: Progress report: The activated coagulation time of whole blood (ACT). Am J Clin Pathol 66: 899-904, 1976 4. McKay DG: Disseminated Intravascular Coagulation—An Intermediary Mechanism in Disease. New York, Harper and Row, 1965, p 493
Dr. Branson's Reply ulation victims even though complement may not be directly involved as a coordinated enzyme effector system. HERMAN E. BRANSON,
M.D.
California College of Medicine University of California Irvine Medical Center 101 City Drive South Orange, California 92668 References 1. Bokish VA, Top FH, Russell PK, et al: The potential pathogenic role of complement in dengue hemorrhagic shock syndrome. N Engl J Med 289:9961000, 1973 2. Harker LA: Hemostasis Manual. Second edition. Philadelphia, F. A. Davis, 1974, p 55
Subacute Myelo-opticoneuropathy Following Pneumonitis To the Editor:—Chambers and associates, in describing a case of subacute myelo-optic-neuropathy (SMON) following pneumonitis (Am J Clin Pathol 66:531-536, 1976) attribute the illness to a virus, based upon a positive 3'/i-year postmortem serologic test for SMON-neutralizing antibody performed in Japan. Unfortunately, in reading this case report and its discusReceived December 27, 1976; accepted for publication February 1, 1977. Key words: Subacute myelo-optico-neuropathy; Myelitis; Pneumonitis; Postmortem serology. Address reprint requests to Dr. Wolfe.
sion, one is given the impression that the only etiology of SMON is a viral infection. Though the etiology of this syndrome is not absolutely certain, there is considerable evidence that the use of 8-hydroxyquinolines such as clioquinol, Mexaform, and Enterovioform2,3 is a much more likely cause of SMON than a virus.1 The patient is reported to have made an extensive trip to Europe and the Middle East immediately antedating the onset of illness, and it would be of great interest to know whether an 8-hydroxyquinoline had been used by the patient during her travels for prevention of diarrhea. The authors should certainly have men-
tioned these drugs in their discussion, as well as whether their patient had used one of them as a prophylactic. MARTIN S. WOLFE,
M.D.
Office of Medical Services Department of State Washington, D. C. 20520 References 1. Cohn HD, Harun JS: Enterovioform in travelers' diarrhea (letter), JAMA 220:276, 1972 2. Nelson E: Subacute myelo-optic-neuropathy (SMON). Ann Intern Med 77: 468-470, 1972 3. Wolfe MS, Mishtowt, Gl: Enterovioform in travelers' diarrhea (letter). JAMA 220:275-276, 1972
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To the Editor: — I believe that Dr. the administration of a potent coagulaHattersley's "nonplussed" posture is tion factor inhibitor such as heparin. unfortunate. While we were not theraIn response to Dr. Bick's letter, I peutic consultants for the ten patients would like to reinforce our advocacy referred to in the article, we subscribe of further assessment of complement to the philosophy of the internist determinations as potential prognostic hematologists of the University of supplements to existing tests of hemoWashington that bleeding in acute dis- stasis. The original intent of the article seminated intravascular coagulation is was to demonstrate that immune mechusually aggravated by heparin adminis- anisms need not be involved in acute tration.2 We reason that patients who disseminated intravascular coagulation have demonstrable platelet dysfunc- for complement consumption to occur. tion, as in our study group, are only Patients with the dengue hemorrhagic further compromised hemostatically by shock syndrome manifested a spectrum of hemorrhagic complications apparently proportional to complement consumption.1 We believe that a similar Received and accepted for publication spectrum exists for non-immunologic February 4, 1977. Address reprint requests to Dr. Branson. acute disseminated intravascular coag-
Vol. 68 • No. I PAUL G. HATTERSLEY,
M.D.
Departments of Internal Medicine and Pathology Sacramento Medical Center 2315 Stockton Blvd. Sacramento, California 95817
References 1. Branson HE, Wyatt LL, Schmer G: Complement consumption in acute disseminated coagulation without antecedent immunopathology. Am J Clin Pathol 66:967-975, 1976 2. Hattersley P: Activated coagulation time of whole blood. JAMA 196:
95 436-440, 1966 3. Hattersley PG: Progress report: The activated coagulation time of whole blood (ACT). Am J Clin Pathol 66: 899-904, 1976 4. McKay DG: Disseminated Intravascular Coagulation—An Intermediary Mechanism in Disease. New York, Harper and Row, 1965, p 493
Dr. Branson's Reply ulation victims even though complement may not be directly involved as a coordinated enzyme effector system. HERMAN E. BRANSON,
M.D.
California College of Medicine University of California Irvine Medical Center 101 City Drive South Orange, California 92668 References 1. Bokish VA, Top FH, Russell PK, et al: The potential pathogenic role of complement in dengue hemorrhagic shock syndrome. N Engl J Med 289:9961000, 1973 2. Harker LA: Hemostasis Manual. Second edition. Philadelphia, F. A. Davis, 1974, p 55
Subacute Myelo-opticoneuropathy Following Pneumonitis To the Editor:—Chambers and associates, in describing a case of subacute myelo-optic-neuropathy (SMON) following pneumonitis (Am J Clin Pathol 66:531-536, 1976) attribute the illness to a virus, based upon a positive 3'/i-year postmortem serologic test for SMON-neutralizing antibody performed in Japan. Unfortunately, in reading this case report and its discusReceived December 27, 1976; accepted for publication February 1, 1977. Key words: Subacute myelo-optico-neuropathy; Myelitis; Pneumonitis; Postmortem serology. Address reprint requests to Dr. Wolfe.
sion, one is given the impression that the only etiology of SMON is a viral infection. Though the etiology of this syndrome is not absolutely certain, there is considerable evidence that the use of 8-hydroxyquinolines such as clioquinol, Mexaform, and Enterovioform2,3 is a much more likely cause of SMON than a virus.1 The patient is reported to have made an extensive trip to Europe and the Middle East immediately antedating the onset of illness, and it would be of great interest to know whether an 8-hydroxyquinoline had been used by the patient during her travels for prevention of diarrhea. The authors should certainly have men-
tioned these drugs in their discussion, as well as whether their patient had used one of them as a prophylactic. MARTIN S. WOLFE,
M.D.
Office of Medical Services Department of State Washington, D. C. 20520 References 1. Cohn HD, Harun JS: Enterovioform in travelers' diarrhea (letter), JAMA 220:276, 1972 2. Nelson E: Subacute myelo-optic-neuropathy (SMON). Ann Intern Med 77: 468-470, 1972 3. Wolfe MS, Mishtowt, Gl: Enterovioform in travelers' diarrhea (letter). JAMA 220:275-276, 1972
Downloaded from http://ajcp.oxfordjournals.org/ by guest on June 6, 2016
To the Editor: — I believe that Dr. the administration of a potent coagulaHattersley's "nonplussed" posture is tion factor inhibitor such as heparin. unfortunate. While we were not theraIn response to Dr. Bick's letter, I peutic consultants for the ten patients would like to reinforce our advocacy referred to in the article, we subscribe of further assessment of complement to the philosophy of the internist determinations as potential prognostic hematologists of the University of supplements to existing tests of hemoWashington that bleeding in acute dis- stasis. The original intent of the article seminated intravascular coagulation is was to demonstrate that immune mechusually aggravated by heparin adminis- anisms need not be involved in acute tration.2 We reason that patients who disseminated intravascular coagulation have demonstrable platelet dysfunc- for complement consumption to occur. tion, as in our study group, are only Patients with the dengue hemorrhagic further compromised hemostatically by shock syndrome manifested a spectrum of hemorrhagic complications apparently proportional to complement consumption.1 We believe that a similar Received and accepted for publication spectrum exists for non-immunologic February 4, 1977. Address reprint requests to Dr. Branson. acute disseminated intravascular coag-
