[CIS PIDD] [cis-pidd] Hypogammaglobulinemia and light chain deposition in kidneys

[Prescott Atkinson, M.D.]

I’ve turned up several CLL patients during the course of evaluation and have never seen any such reactions to immunization or heard of such a problem.  The first patient sounds like pretty aggressive behavior for CLL – wonder if it was just a coincidence that she worsened acutely around the time of immunization.

Prescott Atkinson

University of Alabama at Birmingham
From: Anastasiya Ashurova [mailto:ana.ashurova at gmail.com]
Sent: Wednesday, July 02, 2014 5:14 PM
To: CIS-PIDD
Subject: Re: [cis-pidd] Hypogammaglobulinemia and light chain deposition in kidneys

We would like to elicit your opinion on a case we saw in our office.  An adult patient presented to our office for immune workup in the setting of frequent upper respiratory infections,  IgG of 679mg/dL, non protective diphtheria and pneumococcal titers and most notably CD19 of 1573.  She was subsequently vaccinated with Pneumovax 23 and Td and returned two months later with a large mass over the site of her Td vaccination (left arm) and diffuse lymphadenopathy.  Biopsy of both an axillary lymph node and mass was positive for small lymphocytic lymphoma/CLL.
We now have a patient in our office with CLL, CD19 of 13000 in need of Pneumovax.  What has been your experience in vaccination patients with elevated B cell counts? Has anyone observed “unmasking” or worsening of a lymphoproliferative disorder after immunization?

Thank you,
 Anastasiya Kleva
Fellow, Steven & Alexandra Cohen Children’s Medical Center.




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