[PAGID] IVIG potential benefit?

[Shelly Harvey]

Thank you.  Since her pneumonia 18 months ago, her infections have consisted of mostly viral URI's, sometimes with otitis, C.Diff enteritis (while not on abx), and another poorly defined episode of enteritis that required hospitalization.  All infections have responded to antibiotic therapy.  Her quality of life is mostly affected by her lupus, not infections.

"Sorensen, Ricardo" <RSoren at lsuhsc.edu> wrote:        v\:* {behavior:url(#default#VML);}  o\:* {behavior:url(#default#VML);}  w\:* {behavior:url(#default#VML);}  .shape {behavior:url(#default#VML);}        st1\:*{behavior:url(#default#ieooui) }                The problem with discussing IgG replacement in this patient is that the present clinical status is not defined. How often is the patient sick? How many days of work that she miss due to infections? How often does she require antibiotics? Are antibiotics effective. What is her quality of life, etc. 
   
  The only antibody abnormality seems to be a persistent, mildly decreased IgM. This may signal a dysfunctional antibody production. But this would be irrelevant if there are no documented recurrent infections.
   
  Ricardo U Sorensen, MD
  LSU Health Science Center and Children’s Hospital,
  New Orleans
      
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  From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Charlotte Cunningham-Rundles
Sent: Monday, August 07, 2006 4:59 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] IVIG potential benefit?

   
    these titers sound basically normal to me also, so I'd think not as well.

     

    Charlotte Cunningham-Rundles MD PhD
Professor of Medicine, Pediatrics  and Immunobiology
Mount Sinai School of Medicine
1425 Madison Ave, New York 10029
phone 212 659 9268
fax  212 987 5593

    Email:  charlotte.cunningham-rundles at mssm.edu

     

     

    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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