[CIS PIDD] [cis-pidd] Dysgammaglobulinemia?

[CIS-PIDD]

Colleagues,
You may recall that last fall I posted a pregnant woman with a significant
infection history and a low IgG.

Her history includes:
septic arthritis, N. meningitidis meningitis after vaccination, five
episodes of pneumonia including an MRSA and a Klebsiella, multiple episodes
of bronchitis and three episodes of adenopathy sufficient to merit biopsy -
all reactive lymphoid hyperplasia. She has had some evaluation in the past
that is not yet available. She has been said to be vaccine non-responsive.
Post partum she has had recurrent mastitis. She mentioned that her father
(a physician) has recurrent infection as well but not as troublesome as
hers.

After delivering her baby (mild idiopathic CD3 lymphopenia), I extended her
evaluation:

IgA=129, IgG=526, IgM=256

Serum protein electrophoresis - normal, ANA negative

Response to PPV was not robust but was adequate, 17/23. DT response
adequate as well.

T cells are slightly elevated but CD 3, 4, and 8, CD 4 and 8 memory and
naive cells, CD4 naive CD31+/- were normal as were CD4 and CD8 TEMRA. CD4
memory Tcm was slightly elevated and CD8 Tem was slightly low.

B cells - Total memory, class switched memory, non-switched memory and
naive were all normal.

So, I have this 29 year old woman with a pretty significant infection
history and not much to support significant antibody deficiency.
Suggestions for the best next steps?

Richard Wasserman
Dallas

-- 
Richard L. Wasserman, MD, PhD
Allergy Partners of North Texas
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211

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