[PAGID] DM and hypogamm

[Chinen, Javier]

Dear Dr. Jung, 
My two cents..
To gain more info for a PID diagnosis, I would first look for a decreasing trend and r/o possible losses, first in urine, then GI. This patient's low IgG level would be of significance when the patient presents with frecuent respiratory infections.
If a PID, the association of autoimmunity and several immunodeficiencies is not uncommon and not offer much of a clue. IPEX is one example. He might be at risk I would also look check Coombs and Thyroid function, which are more common targets for autoimmune disease.
Though IVIG has been used for treatment of some autoimmune disorders, it has not been shown to have a prophylactic benefit for autoimmunity.
Fever and fatigue with no focus or etiology is concerning, I would include in the differential malignancy and HIV. Markers for lymphoma/leukemia may be indicated. More info on family and travel history may also provide additional clues.

Javier




 Any suggestions as to the etiology of the "low" IgG's and how may it be
related to the diabetes?Is he at risk for developing other autoimmune
diseases?   Parents ask whether IVIg should be given to prevent
development of the latter.

Message: 1
Date: Thu, 3 May 2007 19:50:28 -0500
From: "Jung, Lawrence" <ljung at chsomaha.org>
Subject: [PAGID] diabetes and hypogammaglobulinemia
To: <pagid at list.clinimmsoc.org>
Message-ID:
	<4C096D8F439EA54FB0B857876DB2A381BE9B84 at chs25.chsomaha.org>
Content-Type: text/plain; charset="us-ascii"

I  have a 15 y.o. previously healthy Caucasian male patient who was
diagnosed to juvenile diabetes last July.  While his diabetes was
controlled he started to develop episodes of low grade fever, fatigue
and searches for infections were never positive.  

 

IgG was 422   IgA 23 and IgM 26.  [ all low for our lab]

IgG1 - 245, IG2 - 30, IgG3 - 22 and IgG4 - 2.   

CD3- 1048, CD4 - 585, CD8- 407, CD19 - 534.  

 

He makes normal levels of antibodies to Diphtheria, tetanus and various
pneumococcal serotypes.  Neg CMV serology.  EBV VCA IgG + IgM - EBNA +
EA -.

 



 


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