Enteropathy may be the first presentation of immunodeficiency or it may occur during the course of the disease and in association with malabsorption in patients affected by primary antibody diseases. For these patients,
immunoglobulin G (
IgG) replacement
therapy prevents infectious and non-infectious complications. Nonetheless some patients cannot achieve optimal
IgG trough levels, even when treated with high Ig doses in absence of
protein-losing syndromes. We investigated seven patients affected by
common variable immunodeficiencies (CVIDs) and treated with high Ig doses (600-800 mg/kg/month) showing low
IgG trough level. Patients underwent abdominal scintigraphy with human polyclonal
immunoglobulin G labeled with 99mTc and with white blood cells labeled by 111
Indium-oxinate to investigate asymptomatic bowel
inflammation. A concentration of labeled leukocytes in abdominal segments greater than that observed with human polyclonal
immunoglobulin G was evident only in one patient. In five patients a slight concentration of both
radiopharmaceuticals was reported, due to mild intestinal inflammatory response. These data might be related to mild increase of capillary permeability in the absence of
inflammation leukocyte mediated. This study discloses a new cause of
IgG-accelerated catabolism due to inflammatory bowel conditions without
diarrhea in CVID patients.