[PAGID] Disseminated mycobacterium

[Ramsay Fuleihan]

Hi Chris!

We had a patient at Yale, who was treated with anti-mycobacterials and  
lost to follow up, but returned with a large abdominal mass that  
eroded her intestines and caused severe anemia from blood loss.  We  
treated her with IFN-gamma and I think it was added after an IL-12 R  
defect seemed likely.  Her therapy was followed by ID, I will ask them  
for an update.  You may want to try IFN-gamma; I have no experience  
with IFN-alpha.  There are very few patients in the US with defects in  
this axis and if your patient has it, she may be the first caucasian  
in the US!

Good Luck,

Ramsay

Ramsay Fuleihan, MD
Associate Professor of Pediatrics
Northwestern University's Feinberg School of Medicine
Division of Allergy and Immunology
Children's Memorial Hospital
2300 Children's Plaza, Box 60
Chicago, IL 60614-3394
Tel:     773-327-1701
Fax:    773-327-3790
e-mail: r-fuleihan at northwestern.edu



On Apr 25, 2008, at 11:45 AM, 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

>

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>

> 600 Highland Ave.

>

> Madison, WI  53792

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>

> fax: 608-265-0164

>

>

>