[PAGID] patient

[Jack Routes]

Chris
I have seen a couple similar patients who had anti-lymphocyte antibodies
that appeared to mediate the CD4 lymphopenia ---In conjunction with Ron
Harbeck, we developed a FACS based assay to look for anti- T cell
antibodies-- we now screen our "idiopathic" CD4 lymphopenia patients using
this assay---the CI lab here can run this assay for you--
Another thing I would check is an ANA----
Good luck
Jack 

-- 
John M. Routes, M.D.
Associate Faculty Member
National Jewish Medical Research Center
Associate Professor of Medicine and Immunology
University of Colorado Health Sciences Center

Address: 1400 Jackson St.; Denver, CO 80206
Phone: 303-398-1291;  FAX: 303-398-1806;  email: routesj at njc.org

> From: "Christine Seroogy" <cmseroogy at wisc.edu>
> Reply-To: pagid at clinimmsoc.org
> Date: Thu, 10 Nov 2005 16:12:54 -0600
> To: pagid at clinimmsoc.org
> Subject: Fwd: [PAGID] patient
> 
> 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
> 
>>> 
>>> 
>>> 
>>>> 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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