[CIS PIDD] [cis-pidd] Possible CVID case

[jag aggarwal]

@Richard:  She has protective titres to 15 out of 23 serotypes of S.
pneumo.  I was hesitant to reimmunize her with Pneumovax.

On Fri, Jan 4, 2013 at 2:27 PM, Richard Wasserman <drrichwasserman at gmail.com

> wrote:



>  The patient is below the lower limit of normal for all three major

> isotypes which would meet the classic definition of CVID. You don't say if

> the pneumococcal titers showed an increase post vaccination. The patient

> may have partially or fully intact memory but not be responsive to a

> neoantigen. It is very likely that IgG therapy would be beneficial.

> Richard Wasserman

> Dallas

>

>

>  On Fri, Jan 4, 2013 at 1:37 PM, jag aggarwal <jag.aggarwal at gmail.com>wrote:

>

>>   I have a 45 y/o female with recurrent sinus infections and four

>> hospitalizations for pneumonia in the last 8 years. Each episode

>> progressively getting worse. Most recent one requiring admission to ICU and

>> was subjected to intensive infectious disease workup. She has no GI

>> problems and no diagnosed autoimmune conditions. She does have significant

>> seasonal allergies

>>

>> Immune work up shows IgA 47 (n 81 - 463 ), IgG 615 ( n 694 - 1618 ), IgM

>> <5 ( N 48 - 271 ), Low IgG2 at 142 ( N 241 - 700 )

>>

>> Antibody titres to Tetenus Normal, antibody titres to S pneum protective

>> range for 15/23 serotypes.

>>

>> Mitogen stimulation to PHA, CON A, PWM normal. Lymphocyte Antigen Screen

>> stimulation indices for Tetenus, Candida and PPD normal.

>>

>> Lymphocyte subset panel all indices in normal range.

>>

>> Immune assessments of B cell subsets (Mayo clinic ) shows: CD19 normal at

>> 11 % , *CD27 low at  4% ( N 6.3 - 52.8% *), *CD27+ IgM- IgD- low at 1.5%

>> ( N 2.3 - 28%),* *CD 27+ IgM+ IgD- only 0.3% ( N 0.0 - 5.3 % *), *IgM+ %

>> of CD19+ B cells high at 82.7% (N 26.0 - 78.0 %* ), CD21+  normal at

>> 98.7% of CD19 B cells, CD21- % of CD19+ B cells normal  at 1.3% all the

>> other indices from Immune assessment of B cells are normal.

>> To me it appears that she fits into MB0 category of Paris classification

>> and for the Euro classification group B+ smB- with CD21,norm.

>>

>> Are we looking a t a new form of Immunedeficiency which si defiend by low

>> numbers of switched memory cells with borderline low levels of IgG and

>> almost absent IgM ?

>>

>> I have two questions:

>> 1.  Does she fit into the cate4gory of CVID

>> 2. Would she benefit from Immunoglobulin replacement therapy even though

>> her antibody titers to Tetenus and S. pneum and all the stimulation indices

>> are normal and her IgG is really not very low although she has low IgA and

>> her IgM level is below the detectable level for the lab.

>>

>> Thanks

>>

>> Jag Aggarwal MD

>> Private practice

>> Ped and Adult Alelrgy Immunology

>>

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>

>

>

> --

> Richard L. Wasserman, MD, PhD

> DallasAllergyImmunology

> 7777 Forest Lane, Suite B-332

> Dallas, Texas 75230

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