[CIS PIDD] [cis-pidd] IgG Levels dropping in XLA patient
CIS-PIDD
cis-pidd at lists.clinimmsoc.org
Mon Jun 19 14:59:33 EDT 2017
Hi Ejaz,
In the best-case scenario, your pt is “gaining weight and height” and the IVIG dose if falling short, but I guess this is just wishful thinking…
If the pt is not losing it (as your results suggest) he is likely consuming it, and 3y old lung opacities (despite the pulmonologists opinion) do deserve a new CT scan and a more directed sampling /biopsy for specific diagnosis and therapy. No lymphoproliferative disease? Is Complement normal? Any renal function deterioration? Is the pt BTK mutation proven or agamm with no B cells? Certain forms of agammm/absent B cell cases are very prone to PCP/PJ infections.
Sergio
Sergio D. Rosenzweig, MD, PhD
Immunology Service, DLM, CC, NIH
mailto:srosenzweig at cc.nih.gov
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From: <cis-pidd at lyris.dundee.net> on behalf of CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
Reply-To: CIS-PIDD <cis-pidd at lyris.dundee.net>
Date: Monday, June 19, 2017 at 1:05 PM
To: CIS-PIDD <cis-pidd at lyris.dundee.net>
Subject: [cis-pidd] IgG Levels dropping in XLA patient
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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