[CIS PIDD] [cis-pidd] Recurrent pneumonia, hypergammaglobulinemia

[CIS-PIDD]

I have followed an now 37yo with Prader-Willi and chronic renal failure s/p
a transplant that was successful for several years and was lost to chronic
rejection. I have followed him for several years with occasional chest
infections but over the past six months he has had recurrent bronchitis and
pneumonia and a significant weight loss. Evaluation is below. I would be
interested in any suggestions for further evaluation.

Thanks,
Richard Wasserman
Dallas


*Lymphocyte Subset *

  % CD3                     72 %                        62-87

! Absolute CD3              1835 cells/uL               570-2400

! % CD4                     33 %                        32-64

! Absolute CD4              853 cells/uL                430-1800

! % CD8                     35 %                        15-46

! Absolute CD8              897 cells/uL                210-1200

! CD4:CD8 Ratio             0.94 ratio                  0.80-3.90

! % Natural Killer Cells

                       [H]  27 %                        4-26

! Absolute Natural Killer Cells

                       [H]  685 cells/uL                78-470

! % CD19               [L]  1 %                         6-23

! Absolute CD19        [L]  34 cells/uL                 91-610

! % CD45RA                  41 %                        28-71

! Absolute CD45RA           379 cells/uL                350-1100

! % CD45RO                  59 %                        28-72

! Absolute CD45RO           542 cells/uL                340-1150

  Comment                   See Note



*B-Cell Memory and Naive Panel *

! B-cells % CD19       [L]  1 %                         5-26

! B-cells Absolute CD19

                       [L]  33 cells/uL                 58-558

! Naive B-cell %CD19+/CD27-/IgD+

                            29 %                        29-93

! Naive BCL Abs CD19+/CD27-/IgD+

                       [L]  10 cells/uL                 22-423

! Non-switched Memory %

                            5 %                         2-25

! Non-switch Abs       [L]  2 cells/uL                  4-66

! Class-switched Memory %

                            20 %                        3-23

! Class-switched Abs        7 cells/uL                  4-62

! IgM Only Memory %         1.4 %                       .3-6.0

! IgM Only Memory Abs  [L]  0.5 cells/uL                .6-16.4

! Total Memory B-cell%CD19/CD27+

                            26 %                        7-48

! Tot Mem BCL Absol CD19+/CD27+

                       [L]  9 cells/uL



*Immunoglobulin G*, Qn, Serum

                       [H]  1633 mg/dL                  700-1600

 Immunoglobulin A, Qn, Serum

                       [H]  491 mg/dL                   90-386

 Immunoglobulin M, Qn, Serum

                            42 mg/dL                    20-172

Immunoglobulin E, Total

                       [H]  1801 IU/mL                  0-100



Protein Electro.,S

 Protein, Total, Serum

                            6.9 g/dL                    6.0-8.5

  Albumin                   3.2 g/dL                    2.9-4.4

  Alpha-1-Globulin          0.2 g/dL                    0.0-0.4

  Alpha-2-Globulin          0.9 g/dL                    0.4-1.0

  Beta Globulin             1.1 g/dL                    0.7-1.3

  Gamma Globulin            1.6 g/dL                    0.4-1.8

 * M-Spike              [H]  0.3 g/dL                    Not Observed*

*    BETA*



  Globulin, Total           3.7 g/dL                    2.2-3.9

  A/G Ratio                 0.9                         0.7-1.7



Immunofixation, Serum

 Immunofixation Result, Serum

                            Note:

    *Immunofixation shows IgA monoclonal protein with no confirmed*

*    light chain association, which is suggestive of*

*    Heavy Chain Disease. Recommend retesting in 6-10 weeks.*





Pneumo Ab Type 1*    [L]  0.1 ug/mL                   >1.3

  Pneumo Ab Type 3*         2.6 ug/mL                   >1.3

  Pneumo Ab Type 4*    [L]  <0.1 ug/mL                  >1.3

  Pneumo Ab Type 8*    [L]  0.1 ug/mL                   >1.3

 Pneumo Ab Type 9 (9N)*

                       [L]  0.3 ug/mL                   >1.3

 Pneumo Ab Type 12 (12F)*

                       [L]  0.5 ug/mL                   >1.3

  Pneumo Ab Type 14*   [L]  0.4 ug/mL                   >1.3

! Pneumo Ab Type 17 (17F)*

                       [L]  1.1 ug/mL                   >1.3

 Pneumo Ab Type 19 (19F)*

                            1.5 ug/mL                   >1.3

! Pneumo Ab Type 2*    [L]  0.3 ug/mL                   >1.3

! Pneumo Ab Type 20*   [L]  0.4 ug/mL                   >1.3

! Pneumo Ab Type 22 (22F)*

                       [L]  <0.1 ug/mL                  >1.3

 Pneumo Ab Type 23 (23F)*

                       [L]  <0.1 ug/mL                  >1.3

 Pneumo Ab Type 26 (6B)*

                            2.7 ug/mL                   >1.3

 Pneumo Ab Type 34 (10A)*

                       [L]  0.2 ug/mL                   >1.3

 Pneumo Ab Type 43 (11A)*

                       [L]  0.2 ug/mL                   >1.3

  Pneumo Ab Type 5*    [L]  0.3 ug/mL                   >1.3

 Pneumo Ab Type 51 (7F)*

                       [L]  0.3 ug/mL                   >1.3

 Pneumo Ab Type 54 (15B)*

                       [L]  0.1 ug/mL                   >1.3

 Pneumo Ab Type 56 (18C)*

                       [L]  <0.1 ug/mL                  >1.3

 Pneumo Ab Type 57 (19A)*

                            6.3 ug/mL                   >1.3

 Pneumo Ab Type 68 (9V)*

                       [L]  0.1 ug/mL                   >1.3

 Pneumo Ab Type 70 (33F)*

                       [L]  0.5 ug/mL                   >1.3



Haemophilus influenzae B IgG

                            0.16 ug/mL



Tetanus Antitoxoid IgG Ab

                            2.39 IU/mL                  <0.10



Diphtheria Antitoxoid Ab

                            0.64 IU/mL                  <0.10

-- 
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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