[PAGID] post gamma globulin psychiatric disorder

[Berger, Melvin]

I would certainly include "organic" causes in the differential and rule them out with an MRI and LP, perhaps a functional PET,  in case there is some active CNS disease, which could be a subtle virus infection. Howeever, I have not seen changes such as those described due to the absence of prersence of IGIV therapy. There is a report of chronic brain syndrome in some CVId patients.
 
Melvin Berger, M.D., Ph.D.
Professor of Pediatrics and Pathology
Case Western Reserve University
phone 216 844 3237
 
Director, Jeffrey Modell Center for Primary Immune Deficiencies
Division of Allergy-Immunology
Rainbow, Babies and Children's Hospital
University Hospitals of Cleveland
RB&C Rm 504, MS 6008B
11100 Euclid Ave.
Cleveland, OH 44106

________________________________

From: pagid-bounces at list.clinimmsoc.org on behalf of Richard L. Wasserman, M.D.,Ph.D.
Sent: Tue 3/11/2008 11:44 PM
To: Pagid list serve
Subject: [PAGID] post gamma globulin psychiatric disorder



I received the following email from the mother of the patient described.
He had hypogammaglobulinemia and vaccine non-responsiveness as a young
child and was treated IV. Reevlaution at about age 12 again demonstrated
vaccine non-responsiveness but resolution of hypogammaglobulinemia. I
recommended stopping IVIG at that time but his parents opted to
contine.  He developed severe infusion related migraine and was treated
sub q for the past several years. Last spring, because he had done well
and was getting ready for college, I again stopped sub q IgG to
reevaluate him. He never returned for his lab studies. He had run away.
This is my first information about him. Any comments for a reply to his
mother?
Thanks,
Richard Wasserman
Dallas

Dr Wasserman, our son has been a patient of yours since he was 2(he is now 18) and stopped taking gamma several months ago. When he was taking the gamma he would feel great after the treatment and by the end of the 3-4 weeks would feel bad....not necessarily sick but just felt bad. His energy would be down and his body hurt. Since he has been off of the gamma he has had a dramatic and devestating change in his personality and ability to function. Not just the I am a teenager and my parents dont know anything change or rebellion. He is presently on his 3rd court order commitment to the psychiatric hospital. He has also been arrested twice in the last 2 months after which they send him to the hospital. He has been diagnosed with major depression, bi-polar, anxiety, ADD, & OCD. He looses major periods of time that he cant account for anywhere from a few days to three weeks. He is now taking several medications a day to help with his various new medical diagnoses.

Have you ever seen a patient that the gamma helped with how they felt and acted and then when stopped had this type of effect?  Our whole family is just beaten down from his behavior and hospital stays over the past 4 months. The last day he acted like himself and he could hold a normal conversation was October 31st. I remember the day clearly as what began to happened a couple of days later is hard to comprehend.The hospital checks him for drugs each time he is admitted and his is always clean.

The therapist tells me I am trying to find a logical answer to an illogical situation. Which I understand but dont want to overlook anything that might help with Phillip's outcome.

Thanks for any ideas you might have.








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