Methods: We describe a 59-year-old obese female (BMI: 48) who presented with persistent asthma and recurrent pulmonary infections. Immunologic evaluation revealed an IgG of 549mg/dL (694-1618), IgM of 152mg/dL (40-230), IgA of 72mg/dL (68-378). She had protective titers to Tetanus and Diptheria, but made a suboptimal response to Pneumovax. Lymphocyte subsets were normal and she had appropriate responses to Candida, Tetanus, PHA, Pokeweed Mitogen, but a diminished response to Con-A. There was no family history of immune deficiency or autoimmune disease. The patient was diagnosed with CVID and treated with Vivaglobin.
Results: One year after her CVID diagnosis, the patient underwent gastric bypass surgery. After losing 56 kg over 8 months postoperatively, she was given a trial off immunoglobulin replacement. Her immunoglobulin levels remained within normal ranges (IgG: 724-799 mg/dL, IgM: 83-101 mg/dL, IgA: 160-180 mg/dL) for 9 months with no inter-current infections, but she still failed to make adequate responses to Pneumovax and Prevnar. Concurrently, the patient developed keratoconjunctivitis sicca, xerostomia, and increased dental caries. Rheumatologic evaluation revealed an elevated ANA with salivary gland biopsy consistent with Sjogren’s. Given a slow trending decline in IgG levels to < 550 mg/dL, re-initiation of subcutaneous IVIG was begun at month 11.
Conclusions: This case demonstrates the transient but potential benefit of weight loss in obese CVID patients. Her case is further highlighted by her Sjogren’s presentation which may have been masked by the anti-inflammatory properties of immunoglobulin replacement therapy. Further research is needed regarding immune deficiency associated with obesity and the effects of immunoglobulin therapy in autoimmune disorders.
Moulin CM, Rizzo LV, Halpern A. Effect of surgery-induced weight loss on immune function. Expert Rev Gastroenterol. Hepatol. 2008;2(5):617-9.