[PAGID] IVIG for ParvoB19?

[Marc Riedl]

Jason,

I follow a 30yo woman who was previously healthy but presented with
persistent parvovirus viremia by PCR identified during evaluation for
chronic fevers, skin rash, and arthritis.  She is has normal QUIGs and
functional Ab studies (including parvo), but was mildly lymphopenic with
poor mitogen and antigen responses.  Her presentation was complicated by
plaquenil therapy which Rheum had prescribed for her arthritis.  Despite the
contention that the plaquenil should not significantly affect her
lymphocytes, her lymphocyte numbers and function improved significantly off
the medication.  Unfortunately the parvo viremia has persisted and though
her symptoms have improved, she wishes to become pregnant.  We have treated
with IVIG using a high-dose protocol and also high-dose followed by lower
maintenance dosing.  Neither approach has been effective in clearing the
virus in her case.

Best,

Marc

Marc Riedl, M.D., M.S.
Assistant Professor of Medicine
Section Head, Clinical Immunology and Allergy
UCLA - David Geffen School of Medicine
10833 Le Conte Ave, 37-131 CHS
Los Angeles, CA  90095-1680
Tel 310.206.4345  Fax 310.267.0090




-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of raas0027 at umn.edu
Sent: Monday, March 09, 2009 11:19 AM
To: pagid at list.clinimmsoc.org
Subject: [PAGID] IVIG for ParvoB19?

Dear Colleagues,

I have a 13 year old male with 6p+4q- translocation and a host of
associated clinical issues.


>From an immune stadpoint, he has T-cell lymphopenia with a baseline CD3 of

under 400/uL. Clinically he has done well from an infection standpoint for
many years. He has normal mitogens as well as normal quantitative and
qualitative antibody response. Lots of other studes performed but to be
brief, were normal.

After 30+ days of nightly fever and modest splenomegaly, a id/heme workup
revealed only a positive PCR for parvovirus b19 in the peripheral blood.

The question of IVIG as treatment for Parvovirus B19 in a lymphopenic
patient was raised. I have never used IVIG in a case like this. Literature
data is spartan.

Any expererience out there?

Thank you!

Regards,

Jason

--


Jason P. Raasch, MD

Midwest Immunology Clinic
City Center Professional Building
15700 37th St NE
Suite 110
Plymouth, MN 55446

Office: 763.577.0008
FAX: 763.577.0192
raas0027 at umn.edu


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