[CIS PIDD] [cis-pidd] 74yo F with Lymphopenia

[Church, Joseph]

Colleagues:

I was referred a 74yo F who over the last 5 years has developed lymphopenia.

She was diagnosed with "CVID" in 2007.  She had recurrent pneumonias and was started on IVIg although her total IgG level was 853.  She did well on IVIg with no further significant infections.  At 'routine follow up' by her PMD  T-cells were shown to be 61% (343) and 5 months later 48% (381).

However, review of her labs demonstrated the low T-cells to be a reflection of a low absolute lymphocyte count, and absolute B-cells were also low.

Most recently:
Absolute Lymphocyte count 600
CD3 45% (273)
CD3,4+ 20% (119)
CD3,8+ 24% (142)
CD19+ 15% (88)
NK  38% (230)

Lymphoproliferation to PHA and PWM were normal.

She has had multiple other medical problems:  COPD (many pack years of smoking), s/p cardiac arrest during surgery, s/p small stroke, s/p major auto accident - all 2011-2013.  Despite these factors on examination she was alert and neurologically intact with good general motor function.

I would very appreciate any suggestions as to the need for and choice of further investigations.  Also, would anyone place on prophylactic antibiotics (PJP, fungus)?

Joe Church
Children's Hospital Los Angeles




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