[CIS PIDD] [cis-pidd] CVID and diarrhoea

[Bodo Grimbacher]

Dear Carla,
We have recently seen a few of these patients in London and in Freiburg.
Some of them only get better on parental nutrition.
To me, the effect of oral IgG or ribavirin is limited but should be tried as
you often stand with the back to the wall.
Fortunately, viral shedding and PCR positivity does not necessarily predict
immune-pathology from the virus.
Also horizontal transmission on the ward or even to household members seem
limited.
Interestingly, adding a bit of corticosteroids may improve immune pathology.

Is the leukopenia part of his CVID (preexisting) or does he loose
lymphocytes via the gut, i.e. It started with the diarrhoea??
Best,
Bodo


****************************************
Univ.-Prof. Dr. med. B. Grimbacher
 
Scientific-Director
CCI-Center for Chronic Immunodeficiency
UNIVERSITÄTSKLINIKUM FREIBURG
Tel.: 0761 270-77731  Fax: -77744
Engesserstraße 4, 79108 Freiburg
bodo.grimbacher at uniklinik-freiburg.de
www.uniklinik-freiburg.de/cci

Von:  "Neumann, Carla  Dr.med." <Carla.Neumann at med.uni-muenchen.de>
Antworten an:  CIS-PIDD <cis-pidd at lyris.dundee.net>
Datum:  Thursday 21 May 2015 16:34
An:  CIS-PIDD <cis-pidd at lyris.dundee.net>
Betreff:  [cis-pidd] CVID and diarrhoea

Dear Colleagues,
I treat a 46 year old patient with CVID (with autoimmune manifestations in
the past with sarcoid like granuloma, splenomegaly and lymphadenopathy,
recurrent pancytopenia and erosive rheumatoid arthritis). The patient is
currently suffering from newly onset leucopenia  (800/µl) of unknown origin
(to us) and from intractable diarrhoea for several months (no infectious
cause, no inflammatory bowel disease in colonoscopy, gluten free diet
because it was beneficial to her in the past). The rheumatoid arthritis was
treated with rituximab more than 1 year ago and prednisolone 5mg/day.
I would appreciate your help concerning the questions:
-          Ideas for treating the diarrhoea (patient is cachectic due to the
massive diarrhoea)
-          Ideas concerning the cause of leucopenia (could the cachexia be
the cause?)
 
Thank you !
 
Yours
Carla Neumann
Outpatient clinic for adult immunodeficiency, Munich, Germany
 
 
__________________________________
Dr. med. Dr. med. univ. Carla Neumann
Internistin/Rheumatologin
AIDA ­ adulte Immundefektambulanz
Rheumaeinheit
Med. Klinik und Poliklinik IV
Klinikum der Universität München
Pettenkoferstrasse 8a
80336 München
Tel: 089/44005-3568
Fax: 089/44005-3719
 
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