[PAGID] ID diagnosis

[Kathleen E. Sullivan]

Giving plasma to dogs with a lupus-like nephritis accelerated the  
process.  The concept became that once you have immune complexes,  
when you give plasma with complement you are feeding the fire.   
Plasma has been shown to be of benefit as prophylaxis but i am not  
sure anyone is using it that way anymore.  I like your idea of  
Rituximab but the action is slow-ish.  It takes about a week.  You  
might need a little cytoxan to get her past this flare.

Kathleen E. Sullivan MD PhD
Chief, Division of Allergy and Immunology
Professor of Pediatrics
The Children's Hospital of Philadelphia
(p) 215-590-1697
(f) 267-426-0363


On Nov 23, 2007, at 2:44 AM, Horacio Del Olmo wrote:


> Hi I wanna comment this case, a 10 years old girl with systemic   

> lupus and C2 deficicncy with otitis media, meningitis ,  

> neumonias ,and  antiphosfolipid   syndrome background. Nowadays we  

> received her with new neumonia,  tromboflebitis in left leg, fever,  

> malar erythema, atonic seizures.

> we used before she come , hydroxycloroquine and GGIV treatment  

> because C2 deficiency, but we consider now ;we have autoimmune  

> activation and infection, what do you think about Rituximab , GGIV  

> and plasma transfusion in this case??? Is it effective? is it  

> useful? any comment? any question? I appreciate your help, thank you

>

> ----- Mensaje original ----

> De: Bodo Grimbacher <bodo.grimbacher at uniklinik-freiburg.de>

> Para: pagid at list.clinimmsoc.org

> Enviado: miércoles, 21 de noviembre, 2007 20:42:56

> Asunto: Re: [PAGID] ID diagnosis

>

> Javier,

> although somewhat invasive, the bone marrow B cell subset as done (and

> published) by e.g. van Dongen in Rotterdam might be reveiling...

> Yours, Bodo

> > I have seen a 14 month-old girl with history of recurrent upper  

> respiratoy infections, with one kidney (the other dysplastic  

> detected in utero and not found posnatal), borderline low IgG,  

> normal IgA and IgM, B cells 1% of lymphocytes (repeated and  

> confirmed), CD4 65%, CD8 15%, NK 15%. Total lymphs 3,600/uL. Height  

> 10 percentile, weight 3 percentile. Not dysmorphic. She has an aunt  

> with history of having one kidney and receiving "immunoglobulin  

> shots", and also she had a splenectomy because "it was not working".

> > The father of this child is Caucasian and the mother is from Mexico.

> > I am measuring reponse to vaccines and will follow up B cells

> > Any suggestion regarding diagnosis is appreciated. Thank you.

> > Javier

> >

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