T helper-suppressor cell imbalance in pyoderma gangrenosum, with relapsing polychondritis and corneal keratolysis

We found decreased T helper/inducer and increased T suppressor/cytotoxic cells in a 45-year-old woman with pyoderma gangrenosum. Serum immunoglobulin levels were normal, suggesting that these T suppressor cells did not function primarily to regulate antibody synthesis. The patient had diminished cutaneous delayed hypersensitivity responses, reacting to only one of six antigens tested, but responded in vitro to three of three antigens. Because of their various regulatory functions, excess T suppressor cells, or a lack of T helper cells, could be a common factor underlying many of the humoral and cell-mediated immune derangements, as well as the neutrophil abnormalities, that have been found in pyoderma gangrenosum. Our patient also had relapsing polychondritis and corneal keratolysis, consistent with the systemic nature of the disorder. The T-cell imbalance persisted even as the ulcer improved. Since monoclonal antibodies against T cell subpopulations are readily available, measuring these cell types as part of the immunological workup of patients with pyoderma gangrenosum might yield valuable clues concerning the pathogenesis of this disorder.