[PAGID] IVIG potential benefit?

[Riedl, Marc]

I'd be unlikely to use IVIG in this setting as the patient has relatively
normal Ab titers.
 
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  90095-1680 
Tel 310.206.4345  Fax 310.206.8107 

-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org]On Behalf Of Shelly Harvey
Sent: Monday, August 07, 2006 10:51 AM
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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