scholarly journals COVID-19 Infection in a Patient with Common Variable Immunodeficiency: Experience with Favipiravir and Intravenous Immunoglobulin

2021 ◽  
Vol 19 (2) ◽  
pp. 118-121
Author(s):  
Emre Emre ◽  
Gökhan Tazegül
Keyword(s):  
Intravenous Immunoglobulin ◽  
Common Variable Immunodeficiency ◽  
Severe Disease ◽  
Treatment Strategies ◽  
Positive Outcome ◽  
Nasopharyngeal Swab ◽  
Increased Risk ◽  
Abstract Data ◽  
Ivig Replacement ◽  
Common Variable

ABSTRACT Data regarding COVID-19 infection in patients with common variable immunodeficiency (CVID) are limited. Herein, we present a 28-year-old male patient with CVID admitted for intravenous immunoglobulin (IVIG) replacement with myalgia and a productive cough. A nasopharyngeal swab for the SARS CoV-2 polymerase chain reaction assay was positive. Chest computed tomography was consistent with COVID-19 pneumonia. The patient refused hospitalization and the applicable treatment for COVID-19. Although he was prescribed IVIG, he had a lapse in IVIG replacement due to supply problems. The patient was later brought to the emergency room due to the deterioration of his general condition with dyspnea, tachypnea, shortness of breath, cough, and fever five days after the initial presentation. He was treated with favipiravir and IVIG and had a positive outcome. Results of COVID-19 infection in CVID patients are diverse, possibly due to underlying genetic defects. Although our patient had an increased risk for severe disease due to CVID, a lapse in IVIG replacement, and obesity, he did not require intensive care or intubation. Further studies are needed to determine and develop treatment strategies for COVID-19 infection in patients diagnosed with CVID. Keywords: COVID-19, common variable immunodeficiency disorders, immunodeficiencies, immunoglobulin, convalescent plasma

scholarly journals Recombinant Human C1 Esterase Inhibitor for the Management of Adverse Events Related to Intravenous Immunoglobulin Infusion in Patients With Common Variable Immunodeficiency or Polyneuropathy: A Pilot Open-Label Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Isaac R. Melamed ◽  
Holly Miranda ◽  
Melinda Heffron ◽  
Joseph R. Harper
Keyword(s):  
Adverse Events ◽  
Intravenous Immunoglobulin ◽  
Common Variable Immunodeficiency ◽  
Treatment Phase ◽  
Open Label ◽  
Ivig Infusion ◽  
C1 Esterase Inhibitor ◽  
Pre Treatment ◽  
Common Variable ◽  
Esterase Inhibitor

It has been hypothesized that low levels of C1 esterase inhibitor (C1-INH), a key inhibitor of the complement pathway, may play a role in the occurrence of adverse events (AEs) associated with intravenous immunoglobulin (IVIG) therapy. This open-label pilot study evaluated C1-INH replacement, with recombinant human C1-INH (rhC1-INH), as a potential therapy for adults requiring IVIG and experiencing AEs. Patients received two rounds of IVIG infusion [pre-treatment phase (no rhC1-INH), 4–8 weeks] and then three rounds of one dose of intravenous rhC1-INH 50 U/kg (maximum, 4,200 U) with subsequent IVIG infusion (treatment phase, 6–12 weeks). Nineteen adults completed the study; all had an autoimmune condition linked to common variable immunodeficiency (CVID) or polyneuropathy, and 57.9% had low baseline C1-INH levels. Mean ± SD total scores improved significantly with the Headache Impact Test (from 62.8 ± 6.2 at pre-treatment to 57.7 ± 9.1 after treatment; mean Δ, −5.0; p = 0.02) and Modified Fatigue Impact Scale (from 59.3 ± 13.1 to 51.2 ± 15.4; mean Δ, −8.1; p = 0.006). Significant improvements in the Migraine Disability Assessment were observed for three of five items (p ≤ 0.002). Mean ± SD C1-INH level increased from 26.8 ± 5.9 mg/dl after the second round of IVIG (pre-treatment) to 32.1 ± 7.8 mg/dl after the third rhC1-INH treatment; functional C1-INH levels increased from 115.8 ± 34.7% to 158.3 ± 46.8%. Future research is warranted to explore the benefit of C1-INH therapy for reduction of IVIG-related AEs, as well as the role of C1-INH in patients with CVID and autoimmune disease.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT03576469.

scholarly journals Case Report: Heparin-induced thrombocytopenia during COVID-19 outbreak: the importance of scoring system in differentiating with sepsis-induced coagulopathy

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 469
Author(s):  
Louisa Fadjri Kusuma Wardhani ◽  
Ivana Purnama Dewi ◽  
Denny Suwanto ◽  
Ade Meidian Ambari ◽  
Meity Ardiana
Keyword(s):  
Scoring System ◽  
Severe Disease ◽  
Scoring Systems ◽  
Pulmonary Infiltrate ◽  
Nasopharyngeal Swab ◽  
Rapid Progression ◽  
Hypoxemic Respiratory Failure ◽  
Heparin Induced Thrombocytopenia ◽  
Heparin Administration ◽  
Increased Risk

Background: COVID-19 disease is accompanied by derangement of coagulation with a risk of fatal thromboembolic formation. COVID-19 patients are among those indicative for heparin treatment. Increased heparin administration among COVID-19 patients increased heparin induced-thrombocytopenia's risk with/without thrombocytopenia. Case presentation: We present a 71-year-old male patient who came to the emergency room (ER) with a COVID-19 clinical manifestation followed by positive PCR nasopharyngeal swab result. He was assessed to have acute respiratory distress syndrome (ARDS), as shown by rapid progression of hypoxemic respiratory failure and bilateral pulmonary infiltrate. He was then treated with moxifloxacin, remdesivir, dexamethasone, unfractionated heparin (UFH) pump, and multivitamins. During admission, his respiratory symptoms got worse, so he transferred to the ICU for NIV support. On the ninth day of admission, he had gross hematuria followed by a rapid fall of platelet count. We used two different scoring systems (4Ts and HEP scoring system) to confirm the diagnosis of heparin-induced thrombocytopenia (HIT). Following the discontinuation of UFH injection, the thrombocyte continued to rise, and hematuria disappeared. Conclusion: Heparin-induced thrombocytopenia is associated with an increased risk of severe disease and mortality among COVID-19 patients. The differential diagnosis of HIT could be difficult as thrombocytopenia can also be caused by the progression of infection. We use two scoring systems (4Ts and HEP scoring) in order to help us managing the patient. These could improve the outcomes, thus avoiding morbidity and mortality.

Risk Factors for In-Hospital Mortality among a Cohort of Children with Clostridium difficile Infection

2015 ◽  
Vol 36 (10) ◽  
pp. 1183-1189 ◽  
Author(s):  
Neika Vendetti ◽  
Theoklis Zaoutis ◽  
Susan E. Coffin ◽  
Julia Shaklee Sammons
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Hospital Mortality ◽  
Severe Disease ◽  
Treatment Strategies ◽  
Severity Of Illness ◽  
Median Number ◽  
Multivariable Logistic Regression Model ◽  
Risk Of Death ◽  
Increased Risk

OBJECTIVEThe incidence of Clostridium difficile infection (CDI) has increased and has been associated with poor outcomes among hospitalized children, including increased risk of death. The purpose of this study was to identify risk factors for all-cause in-hospital mortality among children with CDI.METHODSA multicenter cohort of children with CDI, aged 1–18 years, was established among children hospitalized at 41 freestanding children’s hospitals between January 1, 2006 and August 31, 2011. Children with CDI were identified using a validated case-finding tool (ICD-9-CM code for CDI plus C. difficile test charge). Only the first CDI-related hospitalization during the study period was used. Risk factors for all-cause in-hospital mortality within 30 days of C. difficile test were evaluated using a multivariable logistic regression model.RESULTSWe identified 7,318 children with CDI during the study period. The median age of this cohort was 6 years [interquartile range (IQR): 2–13]; the mortality rate was 1.5% (n=109); and the median number of days between C. difficile testing and death was 12 (IQR, 7–20). Independent risk factors for death included older age [adjusted odds ratio (OR, 95% confidence interval), 2.29 (1.40–3.77)], underlying malignancy [3.57 (2.36–5.40)], cardiovascular disease [2.06 (1.28–3.30)], hematologic/immunologic condition [1.89 (1.05–3.39)], gastric acid suppression [2.70 (1.43–5.08)], and presence of >1 severity of illness marker [3.88 (2.44–6.19)].CONCLUSIONPatients with select chronic conditions and more severe disease are at increased risk of death. Identifying risk factors for in-hospital mortality can help detect subpopulations of children that may benefit from targeted CDI prevention and treatment strategies.Infect Control Hosp Epidemiol 2015;36(10):1183–1189

Granuloma-like lesion at subcutaneous immunoglobulin site in a common variable immunodeficiency patient

Immunotherapy ◽  
2019 ◽  
Vol 11 (14) ◽  
pp. 1177-1180 ◽  
Author(s):  
Ankmalika Gupta ◽  
Beverly Wang ◽  
Sudhir Gupta
Keyword(s):  
Intravenous Immunoglobulin ◽  
Common Variable Immunodeficiency ◽  
Immunoglobulin Therapy ◽  
Subcutaneous Immunoglobulin ◽  
Primary Antibody Deficiencies ◽  
First Case ◽  
Granulomatous Lesions ◽  
Cutaneous Granuloma ◽  
Common Variable ◽  
Switching Treatment

Immunoglobulin therapy is the main stay in the treatment of primary antibody deficiencies. Granulomatous lesions are common complication in patients with common variable immunodeficiency (CVID). We present the first case of cutaneous granuloma-like lesion at site of subcutaneous immunoglobulin injections in a patient with CVID. These lesions resolve overtime following switching treatment to intravenous immunoglobulin. Unlike granulomas associated with CVID, granulomatous lesion in this patient did not require any specific therapy, and resolved over a period of 4 weeks following switching subcutaneous immunoglobulin to intravenous immunoglobulin.

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