[CIS PIDD] [cis-pidd] CVID/IVIg/heparin in patient with h/o PE

[CIS-PIDD]

Dear Katherine,
To me, this is an interesting case.
Has she been hypogammaglobulinemic before receiving rituximab, or is the antibody deficiency secondary?
If it were primary, could the MS be a lymphocytic infiltration of the CNS as we see it in CTLA4 or LRBA immune dysregulation syndromes?
Alike, could the CNS phenotype (and the PE) be secondary to DADA2?
Both of these would require a change of treatment:
DADA2 > anti-TNF and no anticoagulation
Tregopathy (CTLA4/LRBA) > abatacept or alike
Did she respond well to rituximab treatment?
Yours Bodo

****************************************
Univ.-Prof. Dr. med. B. Grimbacher

Scientific-Director
CCI-Center for Chronic Immunodeficiency
UNIVERSITÄTSKLINIKUM FREIBURG
Tel.: 0761 270-77731  Fax: -77744
Breisacherstraße 115, 79106 Freiburg
bodo.grimbacher at uniklinik-freiburg.de
www.uniklinik-freiburg.de/cci

Von: <cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net>> on behalf of CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>>
Antworten an: CIS-PIDD <cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net>>
Datum: Saturday, 16 September 2017 00:00
An: CIS-PIDD <cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net>>
Betreff: [cis-pidd] CVID/IVIg/heparin in patient with h/o PE


Dear colleagues:

I have a newly diagnosed, 37 year old CVID patient who needs IVIg before (and after) receiving rituximab for multiple sclerosis. She was diagnosed with PE in 2009 associated with Crohn disease (otherwise no clear etiology), and treated without complication or recurrent problems when anticoagulation was stopped.


Do any of you routinely give prophylactic subQ heparin (or other anticoagulation practice) before IVIg in patients with a history of PE?

Would you do so in this patient? She is ambulatory and has relatively good functional status in spite of the MS.


Your thoughts would be greatly appreciated.


Katherine


Katherine Gundling, MD, FACP
Clinical Professor
Allergy and Immunology
UC San Francisco
400 Parnassus Ave. Box 0359
San Francisco, CA 94143
Clinic: 415-353-2725
Pager: 415-443-7682

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