[CIS PIDD] [cis-pidd] Woman with CVID and side effects on several different Ig products

[Dr. Esther de Vries]

Dear colleagues,

A 69-year-old woman with pulmonary infections and mild bronchiectasis was found to have CVID (low IgG, IgA, IgM, low responses to polysaccharide (Pneumovax) and protein (tetanus) antigens, low memory B-lymphocytes) and put on IVIG. She suffered severe side effects (swelling, headaches, feeling dizzy) on Nanogam iv, Kiovig iv and Hizentra sc, also with low doses, very slow infusion and/or premedication with prednisolone (iv). She even suffered swelling of subcutaneous sites some time after she had had those infusions when she received an iv dose!

Any suggestions about the reason for these problems? And how we can treat this woman without her having these side effects? At the moment she refuses further treatment, and again suffers from recurrent pulmonary infections. We put her back on antibiotic prophylaxis recently (this did not have enough effect in the past, but is probably better than nothing). 

Thanks for your help!

Esther de Vries, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands


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