[CIS PIDD] [cis-pidd] Severe recurrent sinusitis in a CVID pregnant women

Thu Dec 22 14:37:55 EST 2016

She is a thin lady, 52 Kg. She has used 40 gr of IVIG in the past. I will look after cultures. Thank you very much for your suggestions,

Alejandro Malbran

________________________________
From: CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
Sent: Thursday, December 22, 2016 2:56 PM
To: CIS-PIDD
Cc: Luciana Gadda
Subject: RE: [cis-pidd] Severe recurrent sinusitis in a CVID pregnant women

You should obtain directed cultures via endoscopy for aerobes, anaerobes, fungi and mycobacteria preferably off amoxicillin with minimal anesthesia ( Lidocaine suppresses growth).  She is at significant risk for resistant organisms, fungi, etc. I suggest using a device with a Lukens trap such as the Xomed sinus secretion collector to collect a larger specimen.  Have you done serial IgG levels and correlated them to her symptoms?  What is her weight?

We have used nasal IgG in a few patients with modest success.

Sincerely,

Wellington S. Tichenor, M. D.
642 Park Avenue
New York, New York 10065
212 517-6611
wtichenor at sinuses.com<https://register.concentric.com/home/apps/mail/mbox_compose.cgi?pTo=wtichenor@sinuses.com>

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________________________________
From: CIS-PIDD [cis-pidd at lists.clinimmsoc.org]
Sent: Thursday, December 22, 2016 11:35 AM
To: CIS-PIDD
Cc: Luciana Gadda
Subject: Re: [cis-pidd] Severe recurrent sinusitis in a CVID pregnant women

Thank you very much for your answer.

Surgery once, five years ago. IgG levels right before IVIG infusion last  month. Pregnant, no CAT scan possible right now. She does reasonably well on rifampin / amoxicillin / clavulanate + nasal steroids + nasal washings. But now she is pregnant and I can not find an appropriate treatment for her. Would anybody increase the IVIG dose, would it be useful to use any nasal

medication (beyond mupirocin already done). What about nasal IVIG, any thoughts? Experience?

Alejandro Malbran

________________________________
From: CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
Sent: Thursday, December 22, 2016 12:34 PM
To: CIS-PIDD
Subject: Re: [cis-pidd] Severe recurrent sinusitis in a CVID pregnant women

Has she ever had sinus surgery? When was her last sinus CT and what did it show? When was she last completely well? What was her IgG level at that time?
Richard Wasserman
Dallas

On Thu, Dec 22, 2016 at 9:15 AM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>> wrote:

Dear Sir,

I would greatly appreciate your input to treat a young lady, 16 weeks pregnant, with severe sinusitis. She does nasal washing and takes amoxicillin. Her IgG is 975, no IgA, IgM nor IgE. She is replaced every 4 weeks with 30 gr. Any suggestion is welcome.

Best regards,

Alejandro Malbran

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