Division of Clinical Immunology and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA,
Pain Ther. 2013 Dec;2(2):129-34. doi: 10.1007/s40122-013-0020-0. Epub 2013 Dec 5.
Common variable immunodeficiency (CVID) represents a large heterogeneous group of antibody-deficiency syndromes associated with a wide range of clinical features and a lack of defined causes in the realm of primary immunodeficiencies. Here, we present a case of CVID in a 62-year-old white male patient with a history of longstanding complex regional pain syndrome (CRPS).
His medical history included multiple sinus infections per year and several pneumonias requiring antibiotics. He has had various back surgeries, including a laminectomy at the L4 level 1 year prior to his diagnosis. Thereafter, he underwent four sympathetic nerve blocks with minimal pain relief. Blood chemistries showed a normal white blood cell count with a normal differential, but increased erythrocyte sedimentation rate and C-reactive protein levels. Total Ig (Immunoglobulin)G was 611 mg/dL (normal 700-1,600), IgG1 was 425 mg/dL (341-894), IgG2 was 114 mg/dL (171-632), IgG3 was 14.4 mg/dL (18.4-106), and IgG4 was 7.4 mg/dL (2.4-121). IgA was 47 mg/dL (normal 70-400), IgM was 131 mg/dL (40-230), and IgE was 4.5 kU/L (<4.0). He only had 10 of 23 pneumococcal titers in the protective range post-vaccination. Upon treatment of the CVID with intravenous immunoglobulin, the patient's pain levels were significantly decreased and have been maintained for more than 2 years.
Therefore, immunoglobulin therapy appears to have been beneficial in the treatment of the patient's symptoms of CRPS, including pain. Additional studies investigating the mechanism by which immunoglobulin therapy may reduce the inflammation and pain of CRPS are needed.
普通变异性免疫缺陷（CVID）代表一组与广泛的临床特征相关的抗体缺陷综合征，并且在原发性免疫缺陷中缺乏明确的原因。在这里，我们介绍了一位 62 岁白人男性患者的 CVID 病例，该患者有长期复杂区域疼痛综合征（CRPS）病史。
他的病史包括每年多次鼻窦感染和几次需要抗生素治疗的肺炎。他曾接受过多次背部手术，包括 1 年前在 L4 水平进行的椎板切除术。此后，他接受了四次交感神经阻滞，但疼痛缓解有限。血液化学显示白细胞计数和分类正常，但红细胞沉降率和 C 反应蛋白水平升高。总免疫球蛋白（Ig）G 为 611mg/dL（正常范围为 700-1600），IgG1 为 425mg/dL（341-894），IgG2 为 114mg/dL（171-632），IgG3 为 14.4mg/dL（18.4-106），IgG4 为 7.4mg/dL（2.4-121）。IgA 为 47mg/dL（正常范围为 70-400），IgM 为 131mg/dL（40-230），IgE 为 4.5kU/L（<4.0）。接种疫苗后，他只有 23 种肺炎球菌滴度中的 10 种处于保护范围内。用静脉注射免疫球蛋白治疗 CVID 后，患者的疼痛水平显著降低，并已维持超过 2 年。
因此，免疫球蛋白治疗似乎对治疗患者的 CRPS 症状，包括疼痛有益。需要进一步研究免疫球蛋白治疗减轻 CRPS 炎症和疼痛的机制。
