[CIS PIDD] [cis-pidd] NYC Immunol/Rheum for FMF?

[Haines, Kathleen M.D.]

Yusuf Yasici, MD at NYU.
Kathleen A. Haines, MD


From: Jason Raasch [mailto:jraasch at midwestimmunology.com]
Sent: Monday, April 29, 2013 04:59 PM
To: CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
Subject: [cis-pidd] NYC Immunol/Rheum for FMF?


24 year-old young man with Familial Mediterranean Fever, doing well for years on colchicine.

Now living in NYC  (Manhattan area) and looking to establish care with immunologist/rheumatologist for ongoing care.

Recommendations?

Thanks!

-Jason





Jason Raasch, MD

Midwest Immunology Clinic
15700 37th Ave N, Ste 110
Plymouth, MN 55446

TEL: (763) 577-0008
FAX: (763) 577-0192

[http://www.midwestimmunology.com/images/shell/midwest-immunology-clinic-infusion-center.jpg]





On 4/29/13 11:48 AM, "Zachary D. Jacobs, MD" wrote:

Hello all,

I was sent for immune evaluation via pulmonology a 54 year-old woman with Tuberous Sclerosis and secondary lymphangioleimyomatosis (LAM) and seizure disorder.  She has been having recurrent X-ray and CT proven sinopulmonary infections over the past 12 months.  She is on sirolimus for LAM and has been on this for five years.  She is on four anti-convulsants (divalproex, keppra, lamictal and zonisamide) for control of her seizures, and has been on all of them for several years.

Her IgG is 270 mg/dl, IgA is 34 mg/dl, and IgM is 50 mg/dl.  S. pneumo specific antibody panel showed concentrations above 1.3 mcg/mL in only two of the 23 serotypes, at 2.4 and 3.1.  The remainder were not even close to 1.3.  Tetanus antibody was low-normal at 0.37 IU/mL.  I am awaiting post-vaccination studies but let’s assume for the sake of argument there is no significant response.  CMP and CBC were normal.  Flow cytometry of basic lymphocyte subsets was normal.

I wanted to gauge the community’s thoughts as to whether this is primary or secondary.  I am leaning towards primary CVID.  But, she is on several anti-convulsants, which I know can cause antibody deficiency but have never personally seen.  I do not think the sirolimus could cause these findings, right?  If you think it is secondary, how would you manage it other than starting immunologlobulin replacement?  There are not very many alternatives for seizure control that she is not already on.

Thanks as always for the input.

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

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