[CIS PIDD] [cis-pidd] Patient with low IgM

[CIS-PIDD]

I do not have data on memory B cell subsets but it would be very
interesting to have this information. Thank you very much for your review.

Jennifer Camacho, M.D.
Allergist/Immunologist
Scarsdale Medical Group

On Tue, Oct 20, 2015 at 2:46 AM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
wrote:

> Like Mikko I also wondered about a CVID-like condition, rather than
> selective IgM deficiency. Would you consider molecular studies in this
> regard, and do you have data on memory B-cell subsets (especially any
> reduction in class-switched memory B-cell value?).
>
> It's an interesting case, please give us a follow up in due course.
>
> Regards,
>
> Stan Ress
> Emeritus Associate Professor of Medicine, UCT
> UCT Private Academic hospital
> Observatory, Cape Town
> Tel: 021-4421966/1816
> Cell: 0833115482
> Fax: 0865173095
> Email: Stan.ress at uct.ac.za
>
> Sent from my iPhone
>
> On 19 Oct 2015, at 4:18 PM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
> wrote:
>
> Hello, I was hoping you could provide some insight for a patient that I am
> seeing. Thank you in advance for your help.
>
>
> The patient is a 41 year old male who was referred to me after he
> developed left arm cellulitis after a pneumovax and flu vaccination in
> September 2015. He required 1-2 days of IV antibiotics and completed an
> oral antibiotic regiment.  He also developed pneumonia and sepsis in June
> 2015 after testing positive for the flu vaccine. He required intubation at
> that time and was hospitalized for a few weeks.
>
>
> He has no other history of recurrent infections including sinusitis or
> pneumonia. He was hospitalized in 2012 for alcohol withdrawal. He has a
> history of moderate etoh intake and he was told that he had to be treated
> for alcohol withdrawal during the June 2015 hospitalization as well.
>
> He states he no longer drinks alcohol.
>
>
> He does not have any other significant medical history. He does not have a
> history of asthma or eczema. He was born in the US.  He does not take any
> medications but did receive vivitrol IM injections for 8 months in 2012 for
> etoh abuse.  He is of Irish and Sicilian descent; he is married with three
> young healthy children. His mother passed away from uterine cancer and his
> father had HTN and passed away from heart disease.  He has two sisters, one
> who is in her 40s and has a “positive ANA.” He has a maternal great aunt
> with lupus.  He is self-employed in real estate.
>
>
> His labs are notable for a low IgM.
>
>
> WBC 14.8 (range 4-10), normal Hg, Hct and Platelets, normal differential
>
> BMP/LFTs normal
>
>
> IgG: 494 (range 700-1600 mg/dL) à repeat  605 mg/dL (range 700-1600
> mg/dL)
>
> IgM: 18 (range 40-230 mg/dL) à *repeat 19* (range 40-230 mg/dL)
>
> IgA: 74 (range 91-414 mg/dL) à repeat 92 (range 91-414 mg/dL)
>
> IgG subclass: IgG1: 333 mg/dL (range 422-1292 mg/dL), IgG2: 230 mg/dL
> (117-747 mg/dL), IgG3: 41mg/dL (41-129 mg/dL), IgG4 16 mg/dL (1-291 mg/dL)
>
> IgE 14 IU/mL (range 0-100)
>
>
>
> HIV negative
>
> He is blood group A; he has a positive Isohemagglutinin B titer 1:8.
>
> C3 normal, C4 40 mg/dL (9-36 mg/dL)
>
>
> He has protective titers for diphtheria, tetanus, varicella, rubella and
> H. Influenzae type B.
>
> He does not have protective titers for n. meningitides, mumps, rubeola and
> only has 8/23 protective titers for pneumococcus (2 weeks after pneumovax).
>
>
>
> He has negative titers for HbsAg, HepBs IgM/IgG, HepB core IgM, HepA IgM,
> HCV IgG.
>
>
> A lymphocyte panel including absolute values for CD3: 1452 (range
> 622-2402); CD4: 796 (range 359-1519); CD8 557 (109-897), CD19 348 (12-645)
> is normal.
>
>
> He is ANA negative.
>
>
>
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