[PAGID] Granulomatous disease in CVID

[Berger, Melvin]

We have had patients with severe localized granulomatous disease, high
ACE and lysozyme, in whom we were able to wearn steroids nicely. I think
it is logical to try TNF inhibitors, but I would try just weaning again
first. This was discussed in the Case discussion of the Sept 2005 issue
of Clinical immunology: Cunningham-Rundles, et al, Clim immunol
116-208-210.

 

Mel Berger

 

________________________________

From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Richard Steele
Sent: Wednesday, August 16, 2006 1:15 AM
To: pagid at clinimmsoc.org
Subject: [PAGID] Granulomatous disease in CVID

 

Dear colleagues, I would appreciate your thoughts about the following
patient

 

I have a 16 year old female with CVID and granulomatous disease (lung
infiltrates, hepatosplenometaly) Open lung biopsy showed non-caseating
granulomas, raised serum ACE. Responded well to prednisone in 1998.
Recent recurrence of the same disease, again responded well to high dose
prednisone (almost complete resolution of pulmonary changes, reduction
in hepatosplenomegaly)

 

I am concerned that I will not be able to wean her off the prednisone
without further recurrence, any suggestions? I note case reports using
anti-TNF, is this what others are are using?

 

Regards

 

Dr Richard Steele

Immunologist

Wellington Hospital

Riddiford St

Private Bag 7902

Wellington

New Zealand

64 4 3855999




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