Persistent parvovirus-associated chronic fatigue treated with high dose intravenous immunoglobulin.

We report a 16-year-old boy with no evidence of immunodeficiency who had a 2-year history of chronic fatigue, low grade fever and slapped-cheek rash associated with chronic parvovirus B19 viremia. Prolonged intravenous immunoglobulin therapy resulted in resolution of his symptoms and viremia. Intravenous immunoglobulin may be useful in the resolution of parvovirus viremia regardless of immune status.

Drop-in group medical appointments for patients with asthma: a four-year outcomes study.

Our DIGMA program was established to allow patients time to interact with an allergist, a behaviorist and an asthma educator in a group setting. Weekly meetings targeted patients with chronic asthma. DIGMAs typically last for 90 minute s and include 10 patients per session. Outcome parameters were established to assess the effectiveness of the program over a 4 year time period. Sixty four adult asthmatic patients were enrolled and followed for 4 years. Patients were seen in a group setting in groups of ten. The AQLQ test was administered each year. Spirometry, an analog self assessment scale and the ACT were administered at each visit. Forty two of the 64 patients were followed for a minimum of 3 visits to DIGMA during four years. The average baseline FVC was 85% predicted and remained unchanged. FEV1 was 78% baseline and was 77% at the last determination. Baseline rescue inhaler use was 4 per week compared to 1.5 per week at last visit. ACT scores are 18 at baseline and 19 at last visit. ER claims are 5 at one year prior to enrollment and 2 at the last year of DIGMA. Patient satisfaction improved from 30 to 34 at the last visit. This was an effective, multidisciplinary asthma intervention that focused on behavior. It fulfilled the goals of asthma care as described by the 2007 NAEPP guidelines.

Etanercept treatment of cutaneous granulomas in common variable immunodeficiency.

Common variable immunodeficiency (CVID) is a primary immunodeficiency characterized by hypogammaglobulinemia, poor antibody responses, and recurrent bacterial infections, usually of the sinorespiratory tract. A not uncommon complication is granuloma of the lungs, spleen, liver, and/or skin. We report the case of an 18-year-old boy with CVID and chronic granulomas of the left arm (since 13 years of age) refractory to treatment with antibiotics, intravenous immunoglobulin, antifungal agents, systemic and intralesional steroids, IFN-gamma, cyclosporine, methotrexate, hydroxychloroquine, localized radiation therapy, and surgical excision. The lesions improved after treatment with the systemic administration of the TNF-alpha inhibitor etanercept for 1 year. Etanercept prevents soluble TNF from binding to its cell membrane receptor, leading to inhibition of its inflammatory cascade. We recommend further trials of etanercept in patients with CVID with noninfectious recalcitrant granulomas.