Q:

I have a pt with a neice who I treat for CVID. I tested this new pt's Ig bc she has had recurrent sinus infx - IgE was high but she has allergies. IgG and IgA WNL. IGM has been high in the 300's twice now but SPEP UPEP and serum and urine immunofixation are wnl. Is there any other follow-up test I should send for a high IGM? Thanks!

A:

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.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology