[CIS PIDD] [cis-pidd] VS: Splenic embolization in CVID with massive splenomegaly

[CIS-PIDD]

Hi

We had a quite similar patient who unfortunately recently died of salmonella sepsis.  Male born 1962,  CVI, GLILD, splenomegaly and portal hypertension (oesophageal varices and caput medusae).  In liver biopsy there was mainly sinusoidal CD8 T cell infiltrate. A clonal TCR population was found in the liver and bone marrow, and LGL lymphocytosis in the blood and BM.

In WES  TACI mutation was found. (Might be worth a relook.)  In 2009 CD19 B cells consisted 7% of lymphocytes, no switched memory B cells.  After 2014 B cells have been 0.   CD4 cells 247 /24%. Low naïve T cells and RTE.
Chronic norovirus and diarrhea. Molluscum contagiosum like lesions in skin.

We were preparing with haematologists to treat the LGL lymphoproliferation.

So it could be worthwhile to look for LGL lymphoproliferation.

Best regards

Timi Martelius MD
Inflammation Centre/Infectious Diseases
Helsinki University Hospital
PO Box 348
00029HUS
Helsinki
Finland

Lähettäjä: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org]
Lähetetty: 29. maaliskuuta 2017 5:04
Vastaanottaja: CIS-PIDD <cis-pidd at lyris.dundee.net>
Aihe: [cis-pidd] Splenic embolization in CVID with massive splenomegaly


Dear colleagues,



I am caring for a 50 yo male with 20 years+ history of CVID and massive splenomegaly, portal hypertension with complications of esophageal varices. I was wondering if anyone has experience with debulking spleen through a staged embolization in CVID cases.



Patient now has nearly absent IgGAM, absent vaccine responses, pancytopenia (markedly low ANC, ALC, platelets), GLILD s/p rituximab, massive splenomegaly and ascites. He recently suffered from SBP. There are small granulomas in the liver although do not appear to be significant enough to cause non-cirrhotic portal hypertension. Recent liver biopsy did not show obvious cirrhosis, although there could be sampling error. The imaging was reviewed with radiology and his GI believes that the massive spleen may be drawing significant inflow and resulting significant outflow into the portal vein despite a normal liver. Although they do not treat portal hypertension this way, the GI team thinks he might benefit from debulking of his spleen through a staged embolization so he would still have remaining spleen.



WES has been sent and is pending. We are considering getting a BM biopsy and evaluation for BMT.



I would appreciate any advice regarding treatment of massive splenomegaly resulting in portal hypertension in CVID cases.



Thank you,

Panida



Panida Sriaroon, MD
Associate Professor
Director, Fellowship Program
Medical Director, USF/All Children's Hospital Allergy/Immunology clinic
Beeper 727.825.4379
Office 727.553.3521
E-mail:psriaroo at health.usf.edu

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