[PAGID] pt with recurrent herpes infections and destructive nasal lesion

[Abraham, Roshini S., Ph.D.]

We would be grateful for any suggestions/advice on the following case:

 

19 year old male with history of recurrent herpes viral infections
(zoster, oral but not genital) dating back to childhood.  No Candida
infections.

Granulomatous hepatitis with sinusoidal lymphocytosis and splenomegaly

Present problem - extensive nasoseptal destruction and sinonasal
disease.  Temporary response to antibiotics with relapse.  Nasal biopsy
from 2006 shows an atypical clonal T-cell (mainly CD4 T-cells)
infiltration but not felt to be a T-cell lymphoma but more of a reactive
clonal process.  2nd nasal biopsy results pending.

 

CD4 T-cells = 5864/ul and CD8 = 83/ul.  Normal B and NK cell numbers.
Normal Igs (G, A and M) except IgE previously at 738 and more recently
at 137.

Skin boils that  are erythematous papular lesions occurring on the arms,
legs, back and sometimes on the face.  These are usually warm.
Improvement noted with a topical antibiotic (such as Polysporin).  Some
growth retardation - thought to be due to chronic disease rather than
primary endocrinology problem.

No skeletal anomalies, abnormal facies or episodic fever or diarrhea.

MHC class I expression on PBMCs normal.

 

Thanks,

 

Miguel Park, MD and Roshini S. Abraham

 

 

Roshini Sarah Abraham, Ph.D., D(ABMLI)

Cellular and Molecular Immunology Laboratory 
Department of Laboratory Medicine and Pathology 
Hilton 210 e 
Mayo Clinic 
200 1st St SW 
Rochester, MN-55905 
Ph: 507-266-9292 
Ph (Secy): 507-284-4055 
Fax: 507-266-4088 

 

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