[PAGID] IVIG potential benefit?

[Shelly Harvey]

I have a new 36yo female patient with lupus, recurrent otitis, and s/p a single episode of pneumonia.  The pneumonia occurred 18 months ago after an episode of pleurisy, and was complicated by an empyema requiring surgery, chest tubes, and a prolonged hospital stay.  s/p left tympanoplasty x 2 as child and adult.  No sinus disease ever.  Immune studies reveal normal IgG (950-1200), normal IgA (260-315), and a low IgM (17 after Rituxan - 31 before Rituxan).  First set of pneumococcal titers were drawn 1 year after a Pneumovax, and revealed IgG Ab levels >3.5 ug/mL in 9 of the 14 serotypes.  Repeat pneumococcal titers revealed <2-fold increase in 8 serotypes, 2-fold increase in 3 serotypes, and >2fold increase in 1 serotype, with no change in the remaining 2 serotypes.  Tetanus, diphtheria, and Hib titers all protective.  The specific question for her referral to me is whether or not she could benefit from IVIG.  I think, probably not.  Any thoughts?

 		
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