ABSTRACT
The IgG subclass deficiency is defined as a significant decrease in the serum concentrations of one or more subclasses of IgG in a patient whose total IgG concentration is normal. IgG subclass deficiency can predispose to recurrent sinopulmonary infections. A 29-year-old female patient with a 4-year history of bronchial asthma presented with cough, sputum, dyspnea, and recurrent respiratory infections. She had frequently been treated with antibiotics and systemic steroids for recurrent respiratory infections and acute asthma exacerbations. Chest X-ray and computed tomography showed pectus excavatum and bronchial wall thickening without lung parenchymal abnormalities. On immunological evaluation, she was found to have a low serum IgG3, with normal total IgG concentration. Under diagnosis of selective IgG3 deficiency, she was started on monthly infusions of intravenous immunoglobulin (IVIG) therapy. The frequency and severity of respiratory infections and acute asthma exacerbations were markedly decreased during 3 years of IVIG therapy. Our case report suggests that a patient who has underlying selective IgG3 deficiency and asthma may benefit from IVIG therapy as this can significantly reduce the incidence and severity of recurrent respiratory infections and acute asthma exacerbations.
Subject(s)
Adult , Female , Humans , Anti-Bacterial Agents , Asthma , Cough , Diagnosis , Dyspnea , Funnel Chest , IgG Deficiency , Immunization, Passive , Immunoglobulin G , Immunoglobulins , Immunoglobulins, Intravenous , Incidence , Lung , Respiratory Tract Infections , Sputum , Steroids , ThoraxABSTRACT
Rituximab, an anti-CD20 monoclonal antibody, is an effective target agent against the B lymphocytes in B-cell lymphoid malignancies and various lymphoproliferative diseases. Moreover, the toxicity of rituximab is less severe than that of conventional cytotoxic agents, which has promoted the widespread application of rituximab in the treatment of B-cell lymphoma. However, depletion of B lymphocytes by rituximab, which leads to secondary hypogammaglobulinemia, can cause deterioration of humoral immunity. Although immune reconstitution after hematopoietic stem cell transplantation is known to prevent prolonged hypogammaglobulinemia, very few cases of long-standing hypogammaglobulinemia have been reported. We report herein a case of prolonged hypogammaglobulinemia after rituximab-containing chemotherapy and splenectomy in a patient with non-Hodgkin's lymphoma and discuss the clinical significance and pathogenetic mechanism of this phenomenon with a literature review.
Subject(s)
Humans , Agammaglobulinemia , B-Lymphocytes , Cytotoxins , Drug Therapy , Hematopoietic Stem Cell Transplantation , IgG Deficiency , Immunity, Humoral , Lymphoma , Lymphoma, B-Cell , Lymphoma, Non-Hodgkin , Splenectomy , RituximabABSTRACT
Se reporta el caso de un niño de 6 años de edad con infecciones respiratorias y digestivas recurrentes desde los 8 meses de edad. El estudio inmunológico reveló marcada disminución de la activación linfocitaria, niveles disminuidos de subclases de IgG2, IgG3 e IgG4 y retardo de la fagocitosis. Se estableció el diagnóstico de inmunodeficiencia primaria combinada. Se decidió tratar al paciente con gammaglobulina endovenosa, factor de transferencia e inmunoferón, con una evidente mejoría clínica.
The case of a 6-year-old boy with recurrent respiratory and digestive infections since he was 8 is reported. The immunological study revealed a marked decrease of the lymphocyte activation, reduced levels of subclasses of IgG2, IgG3 and IgG4 and phagocytosis delay. A combined primary immunodeficiency was diagnosed and it was decided to treat the patient with endovenous gamma globulin, transfer factor and immunoferon. An evident clinical improvement was observed.