Persistent immunoglobulin deficiency after prednisolone and antiepileptic therapy in a C2 deficient patient with lupus-like syndrome.

A homozygous C2 deficient patient with a lupus-like syndrome developed hypogammaglobulinemia soon after treatment with prednisolone together with phenytoin, replaced subsequently by carbamazepine. She suffered from recurrent chest infections and her lupus symptoms continued unabated. In vitro tests of immunoglobulin production by her Epstein Barr virus transformed B cells showed typical patterns of reduced IgA and IgG production seen in common variable hypogammaglobulinemia. An opsonisation defect to Hemophilus influenzae was also demonstrated which could be reversed by the addition of pooled human gammaglobulin. Serum IgM and IgG levels returned to normal 2 years after withdrawal of phenytoin and prednisolone, but 3 years later, she remained IgA deficient and the in vitro abnormalities persisted.