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Low IgA, Chronic Sinusitis, pANCA and ANA +
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Low IgA, Chronic Sinusitis, pANCA and ANA +

19 year old female w/Celiac disease - Allergy tests all negative. Pneu. titres low, so was given pneumonia shot to see if she created antibodies properly and was told she did and reacted properly.  However, all colds turn severe, leading to complications, severe swollen glands, pneumonia, wheezing, etc. requiring steroids, inhalers, etc.

CRP & Sed Rate - Normal
pANCA - positive - 34
ANA - positive - 1:1280
IGG - 975 (716-1554)
IGG1 - 568 (382-929)
IGG2 - 193 low (241-700)
!GG3 - 67 (22-178)
IGG4 - 25.5 (4-86)
IGA - 43 low (66-344)
IGM - 38 low (46-208)
CBC ok except for low lymphs 9% (23-53%) and low ABS lymphs .76 (1.2 - 5.4)

Sinus CT scan:
1. Small focus of soft tissue density at the anterior left ethmoid sinus.
2. Mild mucosal thickening at the inferior left maxillary sinus and minimal degree of mucosal thickening of the superomedial left maxillary sinus. There is a tiny focus within the anterior right sphenoid sinus and the posteromedial left frontal sinus.
3. Asymetric enlargement of the inferior left nasal turbinate. There is a left concha bullosa.

Blood in stool and Colonoscopy biopsies came back as "acute colitis" although irritation patchy on/off throughout colon/ilium and in light of pANCA positive, thoughts are to ulcerative colitis or vasculitis-type or allergy type??
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The low immunoglobulin values, especially the low serum IgA, associated with the predisposition to a variety of infections, are quite significant.  And, yes, they suggest both a vasculitis component and cellular immunodeficiency.

This is a very complex problem that will require the expertise of an immunologist/rheumatologist, ideally at an academic medical center, such as the National Jewish Medical and Research Center, the Mayo Clinic or the Cleveland Clinic.  Your doctors are probably quite capable but I strongly suggest that you request a second opinion.
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David Tinkelman, M.D.Blank
National Jewish Health
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