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

[CIS-PIDD]

Dr. Rothenfusser
The low IgG could be due to steroids—certainly looks like it——steroids decrease IgG >>IgA/IgM—the magnitude of the reduction of serum IgG is dependent on the dose and duration of steroids (what is the dose of steroids?) —doubt replacement Ab would be  of value
best
Jack Routes

John M. Routes, MD
Chief, Section of Allergy and Clinical Immunology
Professor of Pediatrics, Medicine, Microbiology and Molecular Genetics
Department of Pediatrics
Children's Hospital of Wisconsin
Medical College of Wisconsin
9000 W. Wisconsin Ave.
Milwaukee, WI  53226-4874
Phone: Office 414-266-6840
Fax: 414-266-6437
Email: jroutes at mcw.edu<mailto:jroutes at mcw.edu>

From: CLINICAL IMMUNOLOGY LISTSERV <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>>
Reply-To: CIS-PIDD <cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net>>
Date: Wednesday, October 28, 2015 at 6:15 AM
To: CIS-PIDD <cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net>>
Subject: [cis-pidd] Patient with reduced immunoglobulin levels and multiple sclerosis

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<mailto:Simon.rothenfusser at med.uni-muenchen.de>
www.klinische-pharmakologie.de





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