Recurrent myelitis in common variable immunodeficiency successfully managed with high-dose subcutaneous immunoglobulin.

Abstract

Acute myelitis is an aetiologically heterogeneous inflammatory disorder of the spinal cord. We report on a 71-year-old woman with a recurrent cervical and thoracic myelitis who presented with a new relapse of the disease. Neuromyelitis optica was ruled out such as other possible causes of acute and/or recurrent myelopathy. Serum immunoglobulin levels and specific antibody responses were consistent with the diagnosis of common variable immunodeficiency (CVID). She was treated with high-dose methylprednisolone and intravenous immunoglobulin. As a remission-maintaining drug, we decided to treat her with subcutaneous immunoglobulin (CSL Behring) at 0.2 g/kg/week at doses higher than usually employed in replacement therapy in CVID. At 3-year follow-up, the response to treatment was good. No relapses occurred. Our case suggests the effectiveness and safety of subcutaneous immunoglobulin in maintaining remission and in sparing prednisone in a woman with recurrent myelitis associated with CVID.

• Authors: Maria Giovanna Danieli, Lucia Pettinari, Lucia Marinangeli, Francesco Logullo
• Journal: BMJ case reports (BMJ Case Rep) Vol. 2012 (Aug 08 2012) ISSN: 1757-790X [Electronic] England
• PMID: 22878981 (Publication Type: Case Reports, Journal Article)

Chemical References

• Autoantibodies
• Immunoglobulins
• Methylprednisolone

Topics

• Aged
• Autoantibodies (blood)
• Common Variable Immunodeficiency (complications, drug therapy, immunology)
• Female
• Humans
• Immunoglobulins (administration & dosage, therapeutic use)
• Injections, Subcutaneous
• Magnetic Resonance Imaging
• Methylprednisolone (therapeutic use)
• Myelitis (diagnosis, drug therapy, immunology)
• Pain (drug therapy)
• Quality of Life
• Recurrence
• Tomography, X-Ray Computed
• Treatment Outcome