[PAGID] CVID fatigue

[Conley, Mary-Ellen]

Hi Harc,
I would look very hard for objective findings that indicate active
disease (ESR, Hgb, LFTs, albumin, renal studies, sinus CT).  You have
probably done all of these.  If these are all normal, I would consider
referring her for psychiatric help.  I would be careful in telling her
that the fatique is real but she needs help in dealing with it.
Sometimes the diagnosis of a chronic disease can tip people over the
edge.
Mary Ellen 






Mary Ellen Conley, MD
Department of Immunology
St. Jude Children's Research Hospital
332 N. Lauderdale
Memphis, TN 38105-2794
FAX  901-495-3977
TEL  901-495-2576


-----Original Message-----
From: pagid-bounces at clinimmsoc.org [mailto:pagid-bounces at clinimmsoc.org]
On Behalf Of Riedl, Marc
Sent: Monday, March 20, 2006 4:07 PM
To: 'pagid at clinimmsoc.org'
Subject: [PAGID] CVID fatigue

I have a 58 yo previously healthy woman recently diagnosed with CVID
(IgG 400, low IgA, h/o respiratory infections) who has suffered from
profound disabling persistent fatigue for the past year. Increasing her
IgG dose has had no effect, nor is the fatigue cyclical related to her
infusions.  We have looked for chronic infection or monoclonal
gammopathy without any findings.  She was formerly a successful,
high-powered attorney and appears very motivated to return to work but
has "no energy".  I have a sizeable number of CVI patients in my
practice and have seen associated fatigue, but not to this degree or
intensity.

Does anyone have experience with this?  Any suggestions are appreciated.


Thanks,

Marc

Marc Riedl, M.D., M.S. 
Assistant Professor of Medicine
Clinical Immunology and Allergy
UCLA - David Geffen School of Medicine
10833 Le Conte Ave, 52-175 CHS
Los Angeles, CA  90095
Tel 310.206.4345  Fax 310.206.8107

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