[PAGID] Patient with PAP

[Abraham, Roshini S., Ph.D.]

We would appreciate some advice on the following case: -

 

64 yo wm with Nocardia brain abscess, pulmonary MAI, positive serology
for Coccidiodes and pulmonary alveolar proteinosis.  He's on alternate
day GM-CSF for the alveolar proteinosis and this has thrown his
WBC/PMNs/Lymphs counts all over the place.  His IgG total (564, lower
limit of normal in our lab is 600) is down a little along with IgG1 and
IgG3 but he has pretty good specific antibody response to tetanus, H.
flu and pneumococcus.  On a day he had normal lymphocyte count, 18 June,
the T and B cell #'s looked normal and B-cell subsets were normal and
IgA and IgM values WNL.  Lymph prolif to PHA - WNL, others not done.  No
history of infections, no family history of immunodeficiency, patient
was a strong smoker but quit a few years ago.

 

1.	Does anyone have an assay to evaluate macrophage function?
Would this be of any value?
2.	Would measuring cytokines be of use, such as IL-2/ IFN-g?  Would
IFN-g therapy be helpful since the response to GM-CSF has not been
optimal - he has had GM-CSF for at least 2 months?
3.	I don't know if he has antibodies to GM-CSF and whether that is
contributing to his non-responsiveness to Neupogen....I don't know if it
was measured in BAL.
4.	Would you give IVIG with his modestly low IgG in the light of
his serious infections?

 

We would appreciate any advice or suggestions regarding further testing
and/or treatment approaches.

 

Thanks!

 

Roshini

 

 

Roshini S. Abraham, PhD., Mayo Clinic, Rochester, MN

John C. Lewis, MD, Mayo Clinic, Scottsdale, AZ

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