[CIS PIDD] recommendations?

[Yeşim Yılmaz Demirdağ]

I think I would still check btk expression on this boy.

Yesim Yilmaz Demirdag, MD
West Virginia University School of Medicine
Morgantown, WV

On Fri, Jul 20, 2012 at 4:23 PM, joseph mittel <joseph.mittel at gmail.com>wrote:


> Hello,

>

> I am caring for a 3 month old boy who was exposed to rituximab as R-CHOP at

> 8, 5 and 2 wks prior to delivery due to his mother’s second trimester

> diagnosis of non-Hodgkin’s lymphoma.  The patient was born at term and

> exclusively formula fed.  He has been healthy, without infections and

> with good weight gain.  However, he has persistently absent CD19 cells,

> IgM and IgA.  His IgG level is below the age appropriate range (table

> below).  Other B cell markers have not been studied yet, but his T and NK

> cell counts are normal.  He received HepB immunization at birth and 2

> month immunizations excluding rotavirus without issue.

>

> There are very few case reports of infants exposed to rituximab in utero,

> and not all of them have been well studied.  However, absence of neonatal

> B cells has been noted in some of these cases.

>

>

>

> Questions:

>

> Has anyone had experience with this?  If so, what did you observe?  Do

> you have any recommendations?

>

>

>

> Lab

>

> Day 1

>

> Day 30

>

> Day 62

>

> CD19+

>

> N/A

>

> 0

>

> 0

>

> IgM

> mg/dL

>

> N/A

>

> 0

>

> 0

>

> IgA

> mg/dL

>

> N/A

>

> 0

>

> 0

>

> IgG (mg/dL)

>

> 656

> (636-1606)

>

> 352

> (251- 906)

>

> 166

> (206-601)

>

> CD3+/cmm

>

> N/A

>

> 3013 (3800-5300)

>

> 3373 (3800-5300)

>

> CD4+/cmm

>

> N/A

>

> 1879 (1580-4850)

>

> 2201 (1580-4850)

>

> CD8+/cmm

>

> N/A

>

> 1166 (680-2470)

>

> 1207 (680-2470)

>

> CD56 +/cmm

>

> N/A

>

> 97 (23-797)

>

> 71 (23-797)

>

> Table 1

>

>

>

>

>

> Thanks,

>

> R. Joseph Mittel

>

> Second Year Allergy Fellow

>

> Rush University

>

> Chicago, IL

>

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