[PAGID] recurrent UTIs and gastritis

[Ashish Kumar]

I have a puzzling patient and would appreciate any ideas. This is a 5 year
old girl who had a few episodes of otitis and URIs in the first 3 years of
life but was otherwise well. Then at age 3 she had pneumonia requiring
hospitalization, and a UTI also requiring hospitalization. Over the last
year she has had influenza, 2 episodes of chicken-pox (clinical diagnosis),
severe EBV gastritis with hematemesis, and pyelonephritis. Her
immunoglobulins have been normal on several occasions, but about a year ago
(when she had gastritis) her tetanus and diphtheria titres were negative
(she has received these immunizations) and she was also missing
isohemaglutinins. This was checked on 2 separate occasions, months apart and
both showed same results. She has since then converted to protective titres
for both tetanus and diphtheria and also has isohemaglutinins (again
confirmed on 2 separate occasions). Her T-cell responses to mitogens and
antigens are normal. She has just developed another bout of UTI, with high
fevers, vomiting and abdominal pain. She has grade 1 vesico-ureteral reflux,
but this can't be blamed for all the problems she has had. Her growth is
above average. The only thing in family history is that her mother had
recurrent fevers while she was pregnant with this child and now has been
given the diagnosis of "asthma" which she acquired during a second
pregnancy. I say asthma in quotes because this diagnosis is based on
wheezing that responded to bronchodilator - she hasn't had pulmonary
function studies. She (the mother) has never had a chest CT. 

Family is concerned about sending this child to kindergarten and is
wondering about prophylactic antibiotics or IVIG. I don't think these are
indicated or would help. Any ideas for diagnosis and management?

Thanks!

Ashish Kumar M.D., Ph. D.
Assistant Professor
Pediatric Hematology/Oncology/Blood and Marrow Transplantation
University of Minnesota