[PAGID] IVIG potential benefit?

[Conley, Mary-Ellen]

To all:
Please remember to sign with your full name, your institution and your
city and state (and country if not obvious).
I agree that Rituximab may have long lasting effects on antibody
concentrations.  You have probably looked at total hemolytic complement?
C2, C3 or C4 deficiency might present with similar findings.
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 

 


________________________________

	From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Shelly Harvey
	Sent: Monday, August 07, 2006 12:51 PM
	To: pagid at clinimmsoc.org
	Subject: [PAGID] IVIG potential benefit?
	
	
	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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