[CIS PIDD] [cis-pidd] Dysgammaglobulinemia?

[CIS-PIDD]

What about her complement?

 

Alexandros Grammatikos

North Bristol NHS Trust

 

From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org] 
Sent: Thursday, February 11, 2016 5:36 PM
To: CIS-PIDD
Subject: [cis-pidd] Dysgammaglobulinemia?

 

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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