[CIS PIDD] [cis-pidd] Patient with reduced immunoglobulin levels and multiple sclerosis

[CIS-PIDD]

Hi all, 

I have seen a patient with slightly reduced immunoglobulin levels (IgG 422
mg/dl; IgA 54 mg/dl; IgM 56 mg/dl) and remitting relapsing multiple
sclerosis for the last 20 years. She herself has no history of severe or
increased infection, and her levels of T cells, B cells/memory B cells and
Nk cells are normal. She has two sons. Both of them have similarly reduced
immunoglobulin levels and one of them suffers from recurrent fevers (most of
the time without a defined infectious cause) and has been put on IvIg about
2 years ago with a clear benefit concerning his fevers and well being.

The patient has been treated so far for her MS mainly with steroids
(Interferon, Azathioprin, Dimethylfumerat have been tried but were all not
tolerated by the patient and stopped after short treatment periods).


Do you think that treating her with scIgG/ivIG Immunoglobulins would help
her concerning her MS?

Would you also think treating her with Natalizumab (she is JC-Antibody
positive) would mean a not-recomendable risk in her situation?

Would you think treating her with Fingolimod would be worth a try without
putting her under to much risk?

Thank you for your experience/recommendations!

Simon

-- 
Prof. Dr. Simon Rothenfusser
Klinikum der Universität München
Division of Clinical Pharmacology
Department of Medicine IV
Lindwurmstr. 2a, 80337 Munich

E-mail: Simon.rothenfusser at med.uni-muenchen.de
www.klinische-pharmakologie.de







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