Multi-organ affecting CMV-associated cryoglobulinemic vasculitis

We report on a 67-year-old female patient who was admitted to our intensive care unit with acute renal failure and severe hypoxemia. Transiently, the patient had to be treated with kidney replacement therapies and artificial ventilation. The actual illness started with general weakness, recurrent bloody diarrhea and intermittent dermatitis of the lower legs. Skin symptoms were initially observed 2 years before the actual clinical findings. The bloody diarrhea was attributed to an inflammatory stenosis of the sigma. The life-threatening clinical aggravation was due to diffuse alveolar hemorrhage and alveolitis. In the search for the cause of the systemic disease, both a monoclonal y-globulinemia, causing a cryoglobulinemia type II and an acute cytomegalovirus infection were diagnosed. Additionally, the course of the disease was complicated by a secondary antibody deficiency as well as an endocarditis of the aortic valve caused by Enterococcus faecium. A cryoglobulinemic vasculitis type II was histologically found in biopsy specimen of the kidney. Thus, the present case reports on a coincidence of a monoclonal gammopathy causing a cryoglobulinemia type II with extensive organ involvement and a florid CMV infection. We hypothesize that the CMV infection has triggered the cryoglobulinemia and its particular severe organ involvement.

[Primary hypoparathyroidism and hypergonadotropic hypogonadism in a male patient with common variable immunodeficiency. A case report]

We describe here a case of a 42-year-old male patient with severe hipogammaglobulinemia primary hypoparathyroidism and hypogonadism, various G1 disorders, malabsorption syndrome, anemia and recurrent severe sinopulmonary infections. We present also difficulties and limitations relating to diagnosis of common variable immunodeficiency and shortly present review of literature.

[Gammaglobulin preparations used for treatment of primary humoral immunodeficiencies]

In the review safety and efficacy of substitution therapy in patients with predominant antibodies immunodeficiencies were presented. Differences between intravenous gammaglobulin preparation has been performed.

[Recurrent respiratory tract infections]

On the occasion of a treatment of frequent infections of the upper respiratory tract an antibody deficiency syndrome was noticed in a 32-year-old female patient. Further investigations revealed a variable immunodeficiency syndrome, a disease belonging to the primary humoral immune defects and presenting with multiple clinical manifestations. Leading symptoms, however, are recurring respiratory infections that may lead to bronchiectasis. Therapy consists in the prevention of infections by periodical intravenous substitution with 7-S immunoglobulins and opportune prescription of antibiotics.

Vaccinia gangrenosa and agammaglobulinaemia

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Antibody protein synthesis by lymph nodes homotransplanted to a hypogammaglobulinemic adult

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Multiple serum protein deficiencies in congenital and acquired agammaglobulinemia

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Vaccinia gangrenosa; a case in a child with hypogammaglobulinemia

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Primary agammaglobulinaemia as a cause of repeated infection in childhood

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