Confused what is going on. Mild hypogammaglobinemia showed in blood work in Feb. Low Igg. Waited a month & dropped a little more. Dr did pneumo vax. Results so-so, (and igg dropped a little more) she did 3 prevnar shots, one every 2 months. Concurrently, CT scan of lungs showed multiple granulomas, some non-calcified. Lung dr said have repeat in 6 months. Immunologist also did B cell phoenotyping profile. She said I was making normal antibodies. To do job movement from burbs to city, I changed primary drs. He referred me to another immunologist. Just before my apt, it was time for repeat CT scan. Lung dr said no change. When I saw the report myself, I was surprised that I now had diagnosis of mild bronchiectasis in right lung. Same granulomas. Another non-calcified granuloma in right lung, which radiologist suggested was probably there but not visible for some technical reason. Also noted several granulomas in spleen. Went to new immunologist, he did pneumovax again. I have allergies & asthma. He wants all my records, wants to see ct scans, including one mentioning spleen. My ”former” immunologist did copy me on records sent to new dr. The b cell test did show cd19+, cd20+ & cd21+ as % of lymphocytes as high, but overall normal. Finally, I recently recovered from a ferocious sinus infection, worst in a few years. It seems to have triggered an asthmatic response. Also developed a quarter size place on my chest that was not caused by anything. New dr says it looks bacterial, not fungus.)
A lot of info crammed in a paragraph. Mildly low Igg, normal b cells indicate not CVID. The symptoms seem to conflict with each other, but yet something must be happening. I don’t understand all the granulomas on the scans and how they got there. Now bronchiectasis, which my former immunologist made a big deal about when the low igg was first discovered. Does anyone have any thoughts?
I have only has IGA, IGM, IGE & subclasses measured once (in March). IGG measured 3 times, last in May. IGG was mildly low. Bronhciectasis is new diagnosis, so something must be going on.
Component Your Value Standard Range Units
IGM QUANT 24 46-304 MG/DL
Component Standard Range 2/17/2012 3/17/2012 5/7/2012
IGG QUANT 751-1560 MG/DL 637 622 605
Component Your Value Standard Range Units
IGA QUANT 123 82-453 MG/DL
Component Your Value Standard Range Units
IGG SUBCLASSES SEE BELOW
HI Expected
Test Result LO Units Values
--------------------------------------------------------------
IgG Subclasses, S
Total IgG 500 L mg/dL 767 - 1590
IgG 1 302 L mg/dL 341 - 894
IgG 2 201 mg/dL 171 - 632
IgG 3 32.3 mg/dL 18.4 - 106.0
IgG 4 4.7 mg/dL 2.4 - 121.0
IMMUNOGLOBULIN E, S (IGE) 72.3 kU/L
-- REFERENCE VALUE --
Mean 13.2
__________
+1SD 41.0
__________
+2SD 127.0
My knowledge of the b cells are limited...i think we have them but they are immature or something. Your IGG is mildly low (not your iga) and IGM, have they given you a vaccine challenge? The last step in dx for CVID is to be given 2 protein type vaccines and wait 3 weeks, draw blood and see if you made antibodies. Usually pneumonia and tetanus/TDP vaccine. You're IGG doesn't have to be bottomed out to have CVID it just may have to be much lower to qualify for IGG from your insurance. I would at least ask for the vaccine challenge...it can't hurt and would explain the bronchectasis. Good luck
