[CIS PIDD] [cis-pidd] HYPERgammaglobulinemia

[Boyce, Thomas G., M.D.]

thanks, I will do an SPEP.  his ALT is 10, sweat chloride normal.

From: bounce-43649007-183824398 at lists.clinimmsoc.org [mailto:bounce-43649007-183824398 at lists.clinimmsoc.org] On Behalf Of dmvascon at usp.br
Sent: Tuesday, July 30, 2013 4:46 PM
To: CIS-PIDD
Subject: Re: [cis-pidd] HYPERgammaglobulinemia


Besides previous suggestions I would like to propose also an autoimmune hepatitis, that usually presents with very high polyclonal IgG levels.
Nevertheless as Daniel suggested I would look for a possible B cell clonality.
Certainly non-immunological diseases as CF and others as suggested previously are important too.

Best,

Dewton

Dewton de Moraes Vasconcelos
University of São Paulo School of Medicine
________________________________
De: "Thomas G. Boyce, M.D." <Boyce.Thomas at mayo.edu>
Para: "CIS-PIDD" <cis-pidd at lists.clinimmsoc.org>
Enviadas: Terça-feira, 30 de Julho de 2013 18:34:27
Assunto: RE:[cis-pidd] HYPERgammaglobulinemia
thanks, forgot to mention normal neutrophil oxidative burst.

From: bounce-43648692-183824398 at lists.clinimmsoc.org [mailto:bounce-43648692-183824398 at lists.clinimmsoc.org] On Behalf Of Church, Joseph
Sent: Tuesday, July 30, 2013 3:37 PM
To: CIS-PIDD
Subject: RE:[cis-pidd] HYPERgammaglobulinemia

Consider:
HIV
CGD
Autoimmune disease including inflammatory bowel disease.
From: Boyce, Thomas G., M.D. [mailto:Boyce.Thomas at mayo.edu]
Sent: Tuesday, July 30, 2013 12:31 PM
To: CIS-PIDD
Subject: [cis-pidd] HYPERgammaglobulinemia

I have been seeing a 5 year old boy for recurrent infections, mostly respiratory.  He has asthma, so some of his recurrent pneumonias may be asthma, but some outside CXRs show consolidation suggestive of true pneumonia.  Initial workup one year ago was normal, except for an IgG of 1800.  I saw him back six months later and repeated it and it was 2600.  I brought him back six months later and today it is 3000 (normal 386-1470).  He has normal T and B cell subsets, negative HIV antibody, normal IgA, IgM, IgD, and IgE.  Normal UA.  Normal sweat chloride. Normal ACE.

I ran it by the peds hematologist to make sure there was not some monoclonal gammapathy to look for and she dismissed the idea in a 5 year old.  I have not seen this degree of elevated IgG before.  Any thoughts?


Thomas G. Boyce, MD, MPH
Pediatric Infectious Diseases and Immunology
Mayo Clinic
email: boyce.thomas at mayo.edu<mailto:boyce.thomas at mayo.edu>
phone: 507-255-8464
fax: 507-255-7767


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