[PAGID] Disseminated mycobacterium

[Kathleen E. Sullivan]

Don't forget CGD.
Kathleen E. Sullivan MD PhD
Chief, Division of Allergy and Immunology
Professor of Pediatrics
The Children's Hospital of Philadelphia
(p) 215-590-1697
(f) 267-426-0363


On Apr 25, 2008, at 12:45 PM, Chris Seroogy wrote:


> Dear Colleagues:

>

> I would like your advice on management of a 19 m/o previously healthy

> caucasion girl who presented 4 days ago with thrombocyopenia and  

> anemia.

> Her bone marrow biopsy revealed numerous AFB+ organisms.  Her blood  

> grew

> mycobacterium and pneumococcus and her stool is growing mycobacterium.

> Further identification is pending.  She has tremendous  

> hepatospenomegaly and

> high fevers.  Family history is incomplete as mother is adopted and  

> parents

> are unlikely related.  She is fully immunized (including live  

> vaccines). ALC

> 2020, IgG and IgM elevated for age. She is being treated with a  

> "cocktail"

> of antimicrobials for mycobacterium per our ID team and  

> vancomycin.  She

> remains critically ill.

>

> It seems likely that she has a defect in IFN-g/IL-12 axis.  We will be

> sending blood to Steve Holland next week.  In the interim, I would  

> like

> opinions about using IFN-g (or perhaps IFN-a if this is a complete  

> IFNR1

> defect.)  Have any of you empirically used IFN-g in this setting?   

> Is there

> any downside?  How rapid should improvement be observed if there is a

> functioning IFNR?  Thank you for your insights, Chris

>

>

> Chris Seroogy, M.D.

>

> University of Wisconsin

>

> 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

>

>

>


-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://seven.pairlist.net/mailman/private/pagid/attachments/20080425/4b84a555/attachment.html>