[CIS PIDD] [cis-pidd] Chronic norovirus enteritis in CVID

[Sokolic, Robert (NIH/NHGRI) [E]]

Fabio Candotti and I had a patient with prolonged norovirus diarrhea after failed gene therapy for ADA-SCID.  We gave oral gamunex (5 mL of the iv preparation mixed with orange juice daily). Diarrhea resolved, but norovirus shedding remained for two years, during which time we continued oral Ig, and then resolved. During that time immunity did not improve.  We based our treatment on papers  describing the use of oral Ig for norovirus after small bowel transplant, which I believe are the same ones to which you refer. If not, I could send them.
Rob Sokolic





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On Jul 16, 2014, at 10:41 PM, "Sriaroon, Panida" <psriaroo at health.usf.edu<mailto:psriaroo at health.usf.edu>> wrote:

Dear colleagues,

We have a 15yo boy with CVID who presents with chronic norovirus enteritis for over 3 months now. He is on SCIG weekly with IgG level around 800s. Past history includes biopsy-proven GLILD treated with rituximab and Imuran a few years ago. He also has lymphopenia and low mitogen responses.

Aside from enteritis, he is doing fine infection-wise. We check his stool every few weeks and he is still shedding the virus. We plan on increasing his SCIG dose to raise the IgG level. In the meantime, his diarrhea is still ongoing (5x or more/d) and he is now losing weight.

I understand that the infection can persist for a prolonged period of time and was wondering if anyone has suggestion for the treatment for norovirus enteritis in CVID. There are several reports of oral Ig therapy given in divided doses for 1-2 days (extrapolated from treatment for rotavirus enteritis) with variable success, but most cases are s/p transplant or on immunosuppression.

We plan on building a case and requesting an authorization for oral Ig use from his insurance--which might not be easy since it is not a proven therapy.

Does anyone have any suggestions for the management of chronic norovirus infection in CVID?

Best,
Panida

Panida Sriaroon, MD
Assistant Professor
Associate Director, Fellowship Program
Associate Director, USF/All Children's Hospital Allergy/Immunology clinic
Beeper 727.825.4379
Office 727.553.3521
E-mail:psriaroo at health.usf.edu<http://health.usf.edu>

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