[CIS PIDD] [cis-pidd] Does this patient warrant IgG therapy?

[Zachary D. Jacobs, MD]

Hello,

I recently saw for evaluation of immune deficiency a 50 year old man with
history of sinus surgery 15 years ago, chronic sinusitis symptoms, and
pansinusitis on limited CT scanning.  He has a history of maybe two
pneumonias in the past ten years, neither of which was documented by
X-ray.  He really has no other medical problems or issues.

On initial lab testing, his IgG was 393 mg/dl, IgA 91 mg/dl, and IgM was 10
mg/dl.  His S. pneumo specific antibody panel (23 serotypes to Mayo) showed
concentrations over 1.3 mcg/mL in 22 of the 23 serotypes.  He had not
recalled receiving Pneumovax before and there was no documentation of him
receiving the vaccine in his medical records. I went ahead and gave him
Pneumovax, and none of his levels changed when rechecked six weeks later:

Serotype 1: 3.2 - 4.3

Serotype 2: 3.7 – 2.5

Serotype 3: 3.7 – 3.0

Serotype 4: 1.5 – 1.3

Serotype 5: 6.0 – 6.4

Serotype 8: 6.8 – 6.8

Serotype 9N: 7.8 – 5.4

Serotype 12F: 2.0 – 2.1

Serotype 14: 9.5 – 9.3

Serotype 17F: 17.6 – 18.7

Serotype 19F: 7.1 – 5.0

Serotype 20: 3.8 -2.8

Serotype 22F: 38.8 – 30.9

Serotype 23F: 37.0 – 34.8

Serotype 6B: 11.2 – 13.4

Serotype 10A: 13.9 – 12.8

Serotype 11A: 2.2 – 3.5

Serotype 7F: 17.1 – 15.6

Serotype 15B: 1.6 – 1.6

Serotype 18C: 0.4 – 0.4

Serotype 19A: 8.9 – 8.1

Serotype 9V: 15.0 – 11.2

Serotype 33F: 2.5 – 2.5

The only other specific antibody I have checked to date is tetanus, which
is normal at 1.61 IU/mL.

 My question is would you place this patient on IgG therapy given the
history, total IgG level and lack of immunogenicity to Pneumovax, despite
that all his S.pneumo antibodies are in the “protective” range above 1.3
mcg/mL?

Thanks as always for any thoughts.

Zach

-- 
Zachary D. Jacobs, M.D.

The Center for Allergy & Immunology

Saint Luke’s Physician Partners
Medical Plaza II
4330 Wornall, Suite 40
Kansas City, MO 64111

Ph: 816.531.0930
Fax: 816.753.2671

 CONFIDENTIALITY NOTICE. This e-mail and attachments (if any) may contain
information that is confidential, proprietary, privileged or otherwise
prohibited by law from disclosure or re-disclosure. This information is
intended solely for the individual(s) or entity(ies) to whom this e-mail or
attachments are addressed. If you have received this e-mail in error, you
are prohibited from using, copying, saving or disclosing this information
to anyone else. Please destroy the message and any attachments immediately
and notify the sender by return e-mail. Thank you.

P *Please consider the environment before printing this message.*

---
The CIS-PIDD listserv is supported by the Clinical Immunology Society
The science & practice of human immunology

P: +1.414.224.8095
E: info at clinimmsoc.org

Not a member of CIS? Please visit www.clinimmsoc.org to join!

You are currently subscribed to cis-pidd as: pagid at list.clinimmsoc.org.
To unsubscribe click here: http://lm.clinimmsoc.org/u?id=183939985.3ea13d40a15475ac00ebbd9cd8a37d6d&n=T&l=cis-pidd&o=42322761
or send a blank email to leave-42322761-183939985.3ea13d40a15475ac00ebbd9cd8a37d6d at lists.clinimmsoc.org
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://seven.pairlist.net/pipermail/pagid/attachments/20121207/bb6a1301/attachment.html>