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

BMJ Case Rep. 2012 Aug 8:2012:bcr0120125637. doi: 10.1136/bcr-01-2012-5637.

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.

Publication types

  • Case Reports

MeSH terms

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

Substances

  • Autoantibodies
  • Immunoglobulins
  • Methylprednisolone