[PAGID] Patient with PAP
Abraham, Roshini S., Ph.D.
Abraham.Roshini at mayo.edu
Thu Jul 17 11:01:54 EDT 2008
Dear John,
He has not and we can easily do that.
Thank you,
Roshini
Roshini Sarah Abraham, Ph.D., D(ABMLI)
Cellular and Molecular Immunology Laboratory
Department of Laboratory Medicine and Pathology
Mayo Clinic
Hilton 210 e
Ph (office): 507-266-9292
Ph (Secy): 507-284-4055
Fax:507-266-4088
________________________________
From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of John Ziegler
Sent: Wednesday, July 16, 2008 11:37 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] Patient with PAP
Roshine
Has he been tested fro a CGD defect?
John
A/Prof. John B. Ziegler
School of Women's & Children's Health, University of NSW
C/o Department of Immunology & Infectious Diseases
Sydney Children's Hospital
High St., Randwick NSW 2031
Australia
T: (02) 93821515
F: + 61 + 2 93821580
E: j.ziegler at unsw.edu.au
________________________________
From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Abraham, Roshini
S., Ph.D.
Sent: Wednesday, 9 July 2008 9:59 AM
To: pagid at list.clinimmsoc.org
Subject: [PAGID] Patient with PAP
We would appreciate some advice on the following case: -
64 yo wm with Nocardia brain abscess, pulmonary MAI, positive serology
for Coccidiodes and pulmonary alveolar proteinosis. He's on alternate
day GM-CSF for the alveolar proteinosis and this has thrown his
WBC/PMNs/Lymphs counts all over the place. His IgG total (564, lower
limit of normal in our lab is 600) is down a little along with IgG1 and
IgG3 but he has pretty good specific antibody response to tetanus, H.
flu and pneumococcus. On a day he had normal lymphocyte count, 18 June,
the T and B cell #'s looked normal and B-cell subsets were normal and
IgA and IgM values WNL. Lymph prolif to PHA - WNL, others not done. No
history of infections, no family history of immunodeficiency, patient
was a strong smoker but quit a few years ago.
1. Does anyone have an assay to evaluate macrophage function?
Would this be of any value?
2. Would measuring cytokines be of use, such as IL-2/ IFN-g? Would
IFN-g therapy be helpful since the response to GM-CSF has not been
optimal - he has had GM-CSF for at least 2 months?
3. I don't know if he has antibodies to GM-CSF and whether that is
contributing to his non-responsiveness to Neupogen....I don't know if it
was measured in BAL.
4. Would you give IVIG with his modestly low IgG in the light of
his serious infections?
We would appreciate any advice or suggestions regarding further testing
and/or treatment approaches.
Thanks!
Roshini
Roshini S. Abraham, PhD., Mayo Clinic, Rochester, MN
John C. Lewis, MD, Mayo Clinic, Scottsdale, AZ
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