Case Report
Symptomatic Secondary Selective IgM Immunodeficiency in Adult Man with Undiagnosed Celiac Disease
Table 1
Immunologic studies.
| | | Result | Reference range |
| | Innate immunity |
| | White blood cell count, 103/L | 6.9 | 4.5–10.8 | | Hemoglobin, g/dL | 14.7 | 13.5–16.9 | | Absolute neutrophil count, 103/L | 4.3 | 2.0–8.1 | | Absolute lymphocyte count, 103/L | 1.8 | 0.9–3.3 | | Absolute monocyte count, 103/L | 0.6 | 0.0–0.8 | | Absolute eosinophil count, 103/L | 0.2 | 0.0–0.54 | | Platelets, 103/L | 184 | 150–450 | | C3, mg/dL | 116 | 90–180 | | C4, mg/dL | 29 | 10–40 | | CH50 U/mL | 240 | 101–300 | | C reactive protein, mg/dL | 0.06 | 0–5 | | Phagocytosis assay (% phagocytosis) | 34.3 | 25–45 |
| | Adaptive immunity |
| | Lymphocyte subsets, N/L (%) | | | | CD3 + T cells | 1349 (75) | 620–1850 (62–84) | | CD3 + CD4 + T cells | 1104 (61) | 345–1200 (31–61) | | CD3 + CD8 + T cells | 257 (14) | 85–730 (10–38) | | CD4/CD8 ratio | 4.3 | 0.9–1.9 | | CD3 − CD19 + B cells | 329 (18) | 50–480 (5–26) | | CD3 − CD56 + NK cells | 134 (7) | 15–350 (1–17) | | Serum immunoglobulins | | | | IgM, mg/dL | 9 | 40–230 | | IgA, mg/dL | 172 | 70–400 | | IgG, mg/dL | 1186 | 700–1600 | | IgG1, mg/dL | 636 | 365–941 | | IgG2, mg/dL | 345 | 165–545 | | IgG3, mg/dL | 52 | 32–116 | | IgG4, mg/dL | 64 | 6–121 | | IgE, mg/dL | 11 | 0–87 |
| | Autoantibodies |
| | ANA | Positive | Negative | | Anti-dsDNA antibody | 4 | Positive: >20 | | Anti-Smith Ab | 11.5 | Negative: <15
Positive: >25 | | ANCA | Negative | Negative | | RF | Negative | Negative | | IgA-tTG (EU/mL) | 14 | Negative: <20
Positive: >25 | | Mitochondrial Ab | Negative | Negative |
| | Serological blood tests |
| | HIV 1,2 Ab, ELISA | Negative | Negative | | HBs-Ag | Negative | Negative | | HCV | Negative | Negative | | TPHA | Negative | Negative | | CMV Ab IgM (AU/mL) | 0.13 | Nonreactive: <6 | | CMV Ab IgG (AU/mL) | >250 | Positive: >20 | | EBV EBNA Ab IgG | 486 | Reactive: >6 |
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Abbreviations: ANA: antinuclear antibodies; ANCA: antineutrophil cytoplasmic antibodies; dsDNA: double-stranded DNA; ELISA: enzyme-linked immunosorbent assay; HIV: human immunodeficiency virus; Ig: immunoglobulin; RF: rheumatoid factor, HCV: hepatitis C Virus; TPHA: treponema pallidum particle agglutination assay; IgA-tTG: IgA anti tissue transglutaminase antibodies; CMV: cytomegalovirus; EBV: epstein barr virus; cpm: counts per minute.
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