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Infectious Diseases

Daughter with high mycoplasma Igg and Igm

11/25/2002

Question:

My daughter is 5, she has a past history of recurrent sinus infections, colds, pneumonia x3, chronic sinusitis which was treated, then 1 year later pansinusitis requiring surgery. She was exposed to mycoplasma pneumonia 7months ago, she was treated with Zithromax x2weeks double dose. Her Igg and Igm continued to both go up then she was treated with Biaxin. Each month she gets her blood drawn her Igg and Igm levels are very high. She has been treated with at least 8 different treatments of Biaxin and Zithromax. I have seen 2 infectious disease doctors, ENT, Immunology, and allergist. She does not have allergies or an immune problem. She just 4 weeks ago had the surgery for pansinusitis. The doctors say they have never seen a case like this where the numbers have stayed elevated this long. She is only five, lives at the doctors office, gets blood drawn often, she even had a picline put in, many different tests, and she also has severe behavior problems due to being sick, not feeling well, and not having a normal childhood life. My questions are specific, and I hope you can help we are so desperate. Our family and daugther is suffering, and doctors do not help. I have had some really bad doctors, who have mistreated her and me, left their office only to find that doctor do the same. Meanwhile, my daugther is still sick. Please, my questions are: Is an Igg of 950 normal range 0-200 and Igm 2100 normal range 0-700 that high after being on antibiotics on and off for seven months? Do you know a special infectious disease doctor that knows or had a case like this one before? My daughter just had her blood redrawn and they still came back high, the doctor is now treating her with 6weeks of Zithromax. I just need to know if there is a doctor or someone I can call to find out more information to help her get better. She does not understand why she is always sick. Please guide me in the right direction. We are in so need of help.

Sincerly, Concerned parent of a beautiful 5 year old girl

Answer:

First, I am unsure if the elevated antibodies are specific for Mycoplasma or just her total circulating immunoglobulins. If the latter, then the normal levels that I am familiar with are not consummate with the levels you are quoting. For IgG, the normal levels range from 9-12 mg/ml of blood or 900 to 1200 micrograms perdeciliter. The IgM levels range from 0.7-1.7 mg/ml or 70-170 micrograms per deciliter. Thus, only the IgM is high. Once elevated IgM will decay with a half-life of 5 days. If she has another infection it will go up again and then start to decay. I would not be so concerned about the elevated immunoglobulin levels, but if so, then I would recommend that a pediatric hematologist be seen. The first question to be asked is about the elevated level of IgM and whether that is a reaction to an infection or whether that is a primary abnormality. It certainly sounds as if she received a sufficient amount of antibiotics.

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Response by:

George S Deepe, Jr, MD George S Deepe, Jr, MD
Professor of Clinical Medicine
Director of Infectious Diseases
College of Medicine
University of Cincinnati