Hypogammaglobulinemia in a renal transplant recipient with antiglomerular basement membrane disease.
A thirty-six-year-old woman developed antiglomerular basement membrane disease, necessitating bilateral nephrectomies. Subsequent to cadaveric renal transplant and 8 years of immunosuppressive treatment with prednisone and azathioprine, the patient developed multiple life-threatening infections. Quantitative immunoglobulins revealed IgG = 9, IgA less than 6.7, and IgM = 33. Lymphocyte population studies revealed absence of B-lymphocytes. It is suspected that prednisone or azathioprine may have caused a defect in B cell differentiation. In patients who are taking immunosuppressive medications and develop multiple infections, it is indicated to evaluate immunoglobulin and/or B lymphocyte status.
Smolin
M R
MR
Department of Medicine, Fitzsimons Army Medical Center, Aurora, CO 80045.
Rickman
W
W
Hasbargen
J
J
D000328:Adult; D000361:Agammaglobulinemia / Q000139:chemically induced / Q000150:complications*; D019867:Anti-Glomerular Basement Membrane Disease / Q000601:surgery; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use; D001485:Basement Membrane / Q000276:immunology; D005260:Female; D005922:Glomerulonephritis, IGA / Q000150:complications* / Q000473:pathology; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007239:Infections / Q000209:etiology / Q000276:immunology; D007678:Kidney Glomerulus / Q000276:immunology; D016030:Kidney Transplantation; D008213:Lymphocyte Activation / Q000187:drug effects; D008231:Lymphopenia / Q000150:complications*; D008934:Mitogens / Q000494:pharmacology; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use
D007070:Immunoglobulin A; D008934:Mitogens; D001379:Azathioprine; D011241:Prednisone