Fwd: [PAGID] patient

[Christine Seroogy]

Dear Colleagues,

I have some additional information on the patient I presented  
recently (see below).  His platelet count and hemoglobin continues to  
steadily normalize.  He remains profoundly lymphopenic and I now have  
some functional studies back.  His in vitro proliferation to mitogen  
and antigen is profoundly low (either reflection of low input or  
intrinsic defect or both).  Measurement of functional antibodies to  
multiple vaccine antigens demonstrated excellent titers for all  
measured.  This included VZV which I failed to mention before he had  
one episode of shingles in 2/05 otherwise no history of infections.   
His platelet size by microscopy looked entirely normal.  His  
examination was notable for complete absence of palpable or visible  
lymphoid tissue.

I have him on PCP and MAC prophylaxis.  Again, I welcome any comments  
or opinions.  Thank you, Chris

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>>> From: Christine Seroogy <cmseroogy at wisc.edu>
>>> Date: October 20, 2005 8:40:53 AM CDT
>>> To: pagid at clinimmsoc.org
>>> Subject: [PAGID] patient
>>> Reply-To: pagid at clinimmsoc.org
>>>
>>> Dear Colleagues,
>>>
>>> I was asked to comment on the possibility of an underlying  
>>> immunodeficiency by one of our hematologists and would like any  
>>> opinions.
>>>
>>> This is a previously healthy 8 y/o boy with onset of bruising 2  
>>> months ago which prompted referral to the hematologist.   
>>> Peripheral blood revealed thrombocytopenia, anemia, and  
>>> lymphopenia. Neutrophil and monocyte numbers normal. His bone  
>>> marrow at the time was hypocellular with rare megas, no blasts,  
>>> normal cytogenetics, absence of fibrosis.  Since then his  
>>> platelet count has stabilized at 30K, hemoglobin 11.1, and his  
>>> ALC remains very low (339).  Flow on his peripheral blood:   
>>> Absolute CD4 26, Absolute CD8 69, Absolute NK 20, normal CD19  
>>> numbers.  Quantitative Igs normal, HIV neg., parvo/CMV/EBV neg,  
>>> ANA neg.  PNH eval. neg and Fanconi's pending, T cell function  
>>> pending, functional antibody levels pending.
>>>
>>> Thank you for your consideration and any thoughts.
>>>
>>>
>>> Chris Seroogy, M.D.
>>> Assistant Professor
>>> Dept. of Pediatrics
>>> Mail:  H4/474 CSC, Mailstop 4108
>>> Shipping:  H4/431 CSC, Mailstop 4108
>>> 600 Highland Ave.
>>> Madison, WI  53792
>>> phone: 608- 263-2652
>>> fax: 608-265-0164
>>>
>>>
>>>
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