[CIS PIDD] [cis-pidd] IgG Levels dropping in XLA patient
CIS-PIDD
cis-pidd at lists.clinimmsoc.org
Mon Jun 19 13:25:10 EDT 2017
This young fellow needs at least a chest x-ray and likely a CT.
Regarding dropping IgG trough levels:
* Look for protein-losing enteropathy: Fecal alpha-1-antitrypsin and calprotectin (for inflammation), and serum albumin
* Proteinuria severe enough to cause loss of IgG would likely be causing nephrotic syndrome.
* Rule-out gut infections including H. pylori (fecal H. pylori antigen) that has been reported to cause PLE. We had a patient with AR-agammaglobulinemia whose IgG trough dropped steadily. We identified H. pylori antigen in the stool; treated him; and his IgGs returned to pre-H. pylori levels.
Joe Church
Children's Hospital Los Angeles
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From: cis-pidd at lyris.dundee.net [cis-pidd at lyris.dundee.net] on behalf of CIS-PIDD [cis-pidd at lists.clinimmsoc.org]
Sent: Monday, June 19, 2017 10:05 AM
To: CIS-PIDD
Subject: [cis-pidd] IgG Levels dropping in XLA patient (EXTERNAL EMAIL)
Dear all
I am managing a 4 years old with XLA. Who has started with chronic cough .Seen by pulmonary who did bronchoscopy which came out normal except some minor growth of H influenza( Fungi, Atypical and Typical TB negative)
He has been treated with several antibiotics including Augmentin, clinda+ cefopodoxime without any significant response . Finally started on Bactrim with some improvement however was stopped due to urticarial reaction and angioedema . Pulmonologist does not feel that a CT scan is required at this time
CT scan done prior to diagnosing XLA ( In 2014 ) showed multiple opacities( as per history I don’t have access to that CT
Another significant trend noted is that he is dropping his pre IVIG IgG levels . He is on currently on about 700 mg/kg of IVIG however his last 3 IgG levels have been dropped from 832 to 784 and now 634( lowest he ever had)
Stool for alpha one antitrypsin is negative
Albumin level is 3.9
Stool for Giardia is negative
Gaining weight and height
No fevers except recently after bronch
Any suggestions why is he dropping his IgG level and any other suggestions for managing his chronic cough
Thanks
Ejaz Yousef MD
Nemours Children Specialty Care
Jacksonville, FL
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