[CIS-PAGID] MMF uselfulness

[Cunningham-Rundles, Charlotte]

I agree with Jack --it seems the safest thing to do, and if  it helps it
would be quicker than other therapies. Let us know if you do that and it
helps?


Charlotte

On 8/29/11 8:11 AM, "Jack R" <jroutes at mcw.edu> wrote:


> I would start with rituximab---I recently treated a patient with CVID, GLILD

> and massive splenomegaly (down to the iliac crest) with rituximab and

> azathioprine---her splenomegaly had an immediate response following the

> rituximab---her  infiltrates are gone and her spleen is nearly normal one year

> out

> 

> 

> 

> John M. Routes, MD

> Chief, Section of Allergy and Clinical Immunology

> Professor of Pediatrics, Medicine, Microbiology and Molecular Genetics

> Department of Pediatrics

> Children's Hospital of Wisconsin

> Medical College of Wisconsin

> 9000 W. Wisconsin Ave.

> Milwaukee, WI  53226-4874

> 

> Phone: 414-456-4802; 414-266-6997

> Fax: 414-456-6487 (Clinical)

> Fax: 414-456-6323 (Laboratory)

> Email: jroutes at mcw.edu

> 

> 

> 

> 

> ________________________________

> From: Pere Soler Palacin <psoler at vhebron.net>

> Reply-To: "pagid at list.clinimmsoc.org" <pagid at list.clinimmsoc.org>

> Date: Mon, 29 Aug 2011 03:39:55 -0500

> To: "pagid at list.clinimmsoc.org" <pagid at list.clinimmsoc.org>

> Subject: [CIS-PAGID] MMF uselfulness

> 

> Dear colleagues, we would appreciate your help in a tough case.

> 

> The patient is a 7 yo boy with hypogammaglobulinemia, autoimmune cytopenias

> and lymphoproliferation (both enlarged lymph nodes and splenomegaly) in whom

> both ALPS and CVID are suspected (DNT cells are 3% but IL-10, vitamin B-12 and

> IgE are normal and lymph node biopsies are inconclusive. Both apoptosis assays

> and FAS mutational analysis are ongoing).

> 

> The current problem is severe chylous ascites after the second biopsy

> (possibly due to lymphatic surgical lesion) that is not responding to TPN and

> IV octreotide. Our question is if starting MMF may be useful in controlling

> lymphatic leakage since it may decrease lymph node enlargement. Would

> corticosteroids be an alternative?

> 

> Thanks in advance.

> 

> Pere.

> 

> 

> Pere Soler Palacín, MD, PhD.

> Pediatric Infectious Diseases and Immunodeficiencies Unit. Hospital

> Universitari Vall d'Hebron.

> Assistant Professor. Universitat Autònoma de Barcelona.

> Passeig de la Vall d'Hebron 119-129.

> 08035 Barcelona. Spain.

> Tel: 0034934893140. Fax: 0034934893039.

> E-mail: psoler at vhebron.net <mailto:psoler at vhebron.net> ; 34660psp at comb.cat

> <mailto:34660psp at comb.cat> . Web: www.upiip.com <http://www.upiip.com/> .

> 

> 

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