Melanin-laden macrophages in cerebrospinal fluid in Vogt-Koyanagi-Harada syndrome
S. Nakamura, M. Nakazawa, M. Yoshioka, I. Nagano, H. Nakamura, J. Onodera and M. Tamai
Department of Neurology, Tohoku University School of Medicine, Sendal, Japan.
OBJECTIVE: To identify basophilic granules in the cytoplasm of macrophages
in cerebrospinal fluid (CSF) smears from patients with Vogt-Koyanagi-Harada
(VKH) syndrome as melanin pigment. DESIGN: Morphological and
immunocytochemical studies were performed on CSF smears obtained from 7
patients with VKH syndrome. Specimens were stained with May-Grunwald and
evaluated by a silver impregnation method (Fontana-Masson staining). For
immunocyto-chemical study, the smear was reacted with mouse anti-human
melanoma cell (HMB-45) monoclonal antibody. RESULTS: Basophilic granules
were detected in the cytoplasm of macrophages in CSF cell smears obtained
from 6 of 7 patients with VKH syndrome in the early stages (within 25
days). Using the silver impregnation method, these basophilic granules were
strongly stained black. Moreover, they were identified as melanin by
positive immunocytochemical staining. The total number of cells containing
cytoplasmic granules ranged from 3 to 8 per 10,000 total cells in CSF. In
contrast, no cells containing cytoplasmic granules were found in control
CSF cell smears from patients with viral, bacterial, or noninflammatory
diseases. CONCLUSION: The identification of melanin-laden macrophages in
the CSF of patients with VKH syndrome suggests that these cells are
responsible for pleocytosis in the immunopathologic process of VKH
syndrome.
