[CIS PIDD] [cis-pidd] 2 children with elevated IgM

[CIS-PIDD]

Thank you all for the suggestions and comments.  In response:

*         Primary MD did Ig levels to show the parents that the kids are healthy

*         There is no evidence of acute or chronic EBV (i.e. no adenopathy or HSM)

*         The IgM levels were done at the same lab but at different dates (we too have had a lab tech enter an extra '0' in an Ig result)

*         SPEP, AFP and total IgE are or will be ordered

Regarding monomeric IgM, where might that be measured?

Joe Church
Children's Hospital Los Angeles

From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org]
Sent: Wednesday, September 30, 2015 11:57 AM
To: CIS-PIDD
Subject: RE:[cis-pidd] 2 children with elevated IgM

Dear Joe
In addition to what others have suggested, would repeat in another laboratory if not already done (sounds silly but have seen similar lab errors in the past)
Otherwise would consider SPEP with IF and check urine for Bence Jones proteins
While rare, gammapathies in children have been reported ...
Maite

Maite de la Morena, MD
Professor of Pediatrics  and Internal Medicine
Division of Allergy and Immunology
University of Texas Southwestern Medical Center in Dallas
5323 Harry HInes Blvd
Dallas, Texas 75390-9063
Phone 214 456-5161
Fax: 214 456-8317
Email: maite.delamorena at utsouthwestern.edu<mailto:maite.delamorena at utsouthwestern.edu>




From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org]
Sent: Wednesday, September 30, 2015 12:59 PM
To: CIS-PIDD
Subject: [cis-pidd] 2 children with elevated IgM

Colleagues:

We are seeing 2 sisters, 2 and 4 years of age, who have histories of minor respiratory tract infections.  There is no family history of immune deficiency or dysfunction.  Physical examinations are normal, and growth and development are normal.

Labs demonstrated normal IgG and IgA levels and normal antibody responses to routine immunizations.  Both children had IgM levels in the 1,500mg/dL range (~10 x upper limit of normal).

I am at a loss to come up with a cause for their "hyper IgM."

Your thoughts would be appreciated.

Joe Church
Children's Hospital Los Angeles



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