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Transition from Systemic Lupus Erythematosus to Common Variable Hypogammaglobulinemia

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Presented in part February 1982 at the Western Section of the American Federation for Clinical Research, Carmel, California. Published in abstract form in Clin Res. 1982;30:56A.

▸Requests for reprints should be addressed to Peter F. Kohler, M.D.; Clinical Immunology (B-164), University of Colorado School of Medicine, 4200 East Ninth Avenue; Denver, CO 80262.

Denver, Colorado

© 1983 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1983;99(1):32-35. doi:10.7326/0003-4819-99-1-32
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A 34-year-old man had polar extremes of B cell dysfunction: systemic lupus erythematosus evolving into common variable hypogammaglobulinemia. He presented in 1974 with seizures and six other criteria for systemic lupus erythematosus; his antinuclear antibody titer was 1:1024 and IgG level, 2870 mg/dL After 5 months of immunosuppressive treatment, a 79% decrease in serum IgG and 95% decrease in IgA levels occurred and manifestations of systemic lupus erythematosus disappeared. Six years later, he developed panhypogammaglobulinemia, had recurrent sinopulmonary infections, and showed nodular lymphoid hyperplasia on rectal biopsy. For comparison, serum immunoglobulin concentrations were measured serially in 13 other patients with systemic lupus erythematosus. Three developed severe depressions of these levels, two with IgG levels less than 300 mg/dL and one with an IgA level of 8 mg/dL. These decreases were transient, related to treatment, and not associated with infections. Daily high-dose prednisone therapy (60 mg/d) rather than treatment with cytotoxic drugs correlated with decreased immunoglobulin concentrations.





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