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

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

Dear Dr. Vasconcelos,

 

Thanks for your note.  He is a Caucasian young man from the Midwest US.  I don't think he has traveled very much in his young life and I also don't think he has had any contact with birds and animals but he did work with handling grain in one of his jobs.  Otherwise he is a student.  I don't think he has lived outside the US.  He is HIV-ve and has normal CD18, CD11a and CD11b in previous testing.

 

We are awaiting the pathology results on the most recent nasal biopsy to make sure there is no malignant process.  We have not tested for neutrophil oxidative burst thus far but that would certainly be feasible to do..........

 

Thanks for the suggestions and we will keep the group posted on developments.

 

Roshini

 

 

________________________________

From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Dewton Vasconcelos
Sent: Tuesday, April 22, 2008 2:36 PM
To: pagid at list.clinimmsoc.org
Cc: Park, Miguel A., M.D.
Subject: Re: [PAGID] pt with recurrent herpes infections and destructive nasal lesion

 

Dear Drs. Park and Abraham

Is this patient an USA native or not? Is he a frequent traveler to forests or caves? Has he contact to birds or other animals?
If he lived (or used to live) in Brazil or other tropical country I would think in rare infectious diseases like leishmaniosis, paracoccidioidomycosis, histoplasmosis, tuberculosis (lupus vulgaris, very uncommon here), and even cryptococcosis. 
HIV infection must be discarded, as well as other forms of immunodeficiency. In such case even HSV infections can lead to ulcerative lesions. We have seen genital HSV infection in a CD18 deficient patient leading to an extensive necrotic lesion. HSV can also lead to lesions similar to nasal lymphoma (Mod Pathol 2003;16(2):166-172). NK-T cell lymphomas and chronic myelomonocytic leukemias could also present as mucocutaneous destructive lesions.
Environmental fungi as Mucor, Rhizopus, Acremonium etc. can provoke severe lesions in phagocyte deficient patients such as CGD patients.

Please keep us updated.

Best regards,

Dewton de Moraes Vasconcelos, M.D.; Ph.D.
University of São Paulo School of Medicine


Abraham, Roshini S., Ph.D. escreveu: 

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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