[PAGID] Disseminated mycobacterium

[Chris Seroogy]

Thank you all for the helpful suggestions!  I will keep you posted.  Chris


On 4/25/08 5:20 PM, "Ramsay Fuleihan" <r-fuleihan at northwestern.edu> wrote:


> 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

>> 

>> Shipping:  H4/431 CSC, Mailstop 4108

>> 

>> 600 Highland Ave.

>> 

>> Madison, WI  53792

>> 

>> phone: 608- 263-2652

>> 

>> fax: 608-265-0164

>> 

>> 

>> 

>