[CIS PIDD] [cis-pidd] C1q deficiency

[CIS-PIDD]

Hello Dominic,

If you are able to send the complement for confirmation, can I suggest you add a C2 function, in case it is a type II deficiency.  It may be useful to add testing for circulating immune complexes as there is already signs of autoimmune.

We are working on a panel of 50 complement genes, but it is still in research and validation.  I can verify that C1q is included if that would be helpful.

Regards,
Ashley

Ashley Frazer-Abel, PhD, D(ABMLI)
Director, Complement Laboratory
303.270.2546 Office
303.270.2541 Laboratory
303.270.2185 Fax
303.588.4334 Cell
Frazer-AbelA at njhealth.org
njlabs.org |njhealth.org

From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org]
Sent: Friday, January 29, 2016 3:40 PM
To: CIS-PIDD
Subject: [cis-pidd] C1q deficiency

I would like the opinion of the group regarding a 5 yo girl who presented with an SLE like syndrome whom I suspect of a C1q deficiency.

She presented 4/2015 with arthralgias, malar rash and on further workup was found to have:
- ANA > 1:2560, anti-dsDNA 5235, positive SS-A
- Coombs + anemia, leukopenia, lymphopenia
- C3: 25 (normal 84-168), C4: < 6 (normal 13-44)
- Renal Bx showed Class IV SLE nephritis with large blood, nephrotic range proteinuria (protein:creat ratio 4-8) and low albumin (3.3)

Received PCV13 about 2 weeks prior to presentation. Whole family was ill with GI bug around the time of presentation. She had a history of sinusitis that did not clear up with antibiotics, but has not had any other serious infections and has consistently been in 80%ile for ht/wt (until we started steroids and her wt is >99.9999%ile)

We treated her with steroids and mycophenolate, but though she has some initial improvement in complements in the first few months, her complements were still borderline (C3 – 80-90 (normal 89-168 in our lab), C4 – 8-9 (normal 13-44 in our lab) and protein:creat ratio hovered around 1. Repeat renal Bx shows persistent class IV nephritis, with no significant fibrosis, so we pulsed her and are starting Cytoxan.

However, in the meantime, we sent C1q/r/s and C2. C1r/s pending. C1q level at Quest < 3.6 (below assay limit, normal 5-8.6) and C2 level 1.4 (normal 1.6-3.6 in our lab).

I am planning to repeat complement studies at National Jewish to confirm.

My questions:
1. Does anyone know of a lab that does clinical sequencing of C1q?
2. What would you suggest for treatment if cytoxan doesn't work for her nephritis. I've seen FFP infusions and BMT, though BMT seems a little extreme.

Thanks in advance for any insight you can offer,

Dominic

Dominic Co, MD PhD
Assistant Professor
Medical College of Wisconsin
Milwaukee, WI



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