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

[CIS-PIDD]

Dear all,
I think treating her with IVIG (MS Tx dosing) may catch two birds with one stone, MS and antibody deficiency, so I like your approach.
Rituximab is an interesting approach but cave JC infection.
How is her T cell immunity wrt T cell subsets and function?
Genetically, I would exclude CTLA4 (as it is an AD trait).
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<mailto:bodo.grimbacher at uniklinik-freiburg.de>
www.uniklinik-freiburg.de/cci

And

Consultant Immunologist
Institute of Immunity & Transplantation
Dept of Immunology
Royal Free Hospital
UNIVERSITY COLLEGE LONDON
Pond Street
London NW3 2QG
b.grimbacher at ucl.ac.uk<mailto:b.grimbacher at ucl.ac.uk>
www.centreforimmunodeficiency.com


Von: CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>>
Antworten an: CIS-PIDD <cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net>>
Datum: Wednesday 28 October 2015 13:15
An: CIS-PIDD <cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net>>
Betreff: [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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