Thank you for your recent inquiry.
There are of course two things that one considers with an elevated IgM:
- A monoclonal gammopathy.
- Hyper-IgM deficiency syndrome.
Usually, in both instances, the elevated IgM is higher than that described in your patient and if immunodeficiency is present, it usually manifests itself in childhood, and is characterized by recurrent pneumonias, bronchiectasis, and documented sinusitis.
You have ruled out a monoclonal gammopathy with your studies and need not proceed further there. From reading the description of your patient, I did not feel that she had profound manifestations of immunodeficiency as mentioned above. However, if I have misinterpreted this, then further immunologic workup would be indicated. If, however, she simply has recurrent respiratory viral infections, I do not think further workup would be of help.
If I have misinterpreted the severity of her respiratory tract infections, then you might consider getting objective confirmation of recurrent bacterial infections (sinus CT scan, chest CT scan for bronchiectasis, et cetera). If none are present, then it would be very unlikely that she would be a candidate for further immunologic workup at this time.
Thank you again for your inquiry and we hope this response is helpful to you.
Phil Lieberman, M.D.