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

[dmvascon at usp.br]

Dear Zachary 

I would follow him closely (e.g.: twice a year at last) recommending to him in the event of any infection to look for you for a clinical evaluation. 

Best regards, 

Dewton Vasconcelos 
University of São Paulo School of Medicine 

----- Mensagem original -----


> De: "Zachary D. Jacobs, MD" <zjacobs.md at gmail.com>

> Para: "CIS-PIDD" <cis-pidd at lists.clinimmsoc.org>

> Enviadas: Sexta-feira, 7 de Dezembro de 2012 15:49:31

> Assunto: [cis-pidd] Does this patient warrant IgG therapy?



> 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



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