Abstract
A patient with a history of recurrent cutaneous and pulmonary infections, nephrotic syndrome, and an established diagnosis of type 1 diabetes was found to have unsuspected and unrecognised primary immunodeficiency. On review of the case, previous investigations pointed to the correct diagnosis over 10 years earlier. This combination of diagnoses has not previously been reported. The patient is now well on replacement intravenous immunoglobulin therapy, urinary loss of IgG having been specifically excluded before treatment. This case highlights how antibody deficiency can easily be missed despite an obvious infection history unless results are interpreted carefully and in context.
Key Words: diabetes mellitus • nephrotic syndrome • primary immunodeficiency
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Figure 1 Serum and urine IgG responses (over 35 days of follow up) to a 24 g intravenous immunoglobulin infusion. An initial serum IgG bolus effect was followed by equilibration over two days, with subsequent decline consistent with the known half life of intravenous immunoglobulin. No IgG detected in the urine at any time.