[PAGID] lymphopenia

[Sorensen, Ricardo]

Richard,

 

I would measure CD4+ cells in his parents and siblings. One or more may
have the same lymphopenia without any symptoms. I would consider that
reassuring. In any case, I have followed patients with CD4+ counts much
lower than your patient. They came to medical attention  either through
routine test results or because they developed transient, unusual
infections during special situations, e.g. pregnancy or extreme stress.

 

Best,

 

Ricardo Sorensen

 

________________________________

From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Jung, Lawrence
Sent: Tuesday, January 06, 2009 12:09 AM
To: pagid at list.clinimmsoc.org
Subject: RE: [PAGID] lymphopenia

 

Richard,

I would check for evidence of autoimmunity such as lupus; for example,
the neuropsychiatric illness may be CNS lupus and the leukocytopenia
secondary to anti-neutrophil and anti-lymphocyte antibodies.

 

Larry Jung, M.D.

Children's National Medical Center

Washington, DC

 

________________________________

From: pagid-bounces at list.clinimmsoc.org on behalf of Richard L.
Wasserman
Sent: Mon 1/5/2009 9:51 PM
To: PAGID
Subject: [PAGID] lymphopenia

A 13-year-old boy was referred to heme/onc for evaluation of leukopenia
of several years duration. He has no significant infections by history.
He has been treated for neuropsychiatic problems with trileptal,
welbutrin, Zoloft, Depakote and Concerta. At this time he only takes
Concerta and has not had any other medication in more than six months.

Physical examination was normal.

Over the past five years lymphocyte counts have ranged from 500 to 1200.
Most recently, B cell and NK cell number were normal; CD 4 was 300 and
CD8 250.

Does he need additional evaluation for this laboratory abnormality with
no clinical correlate?
Richard L. Wasserman, MD,PhD
Dallas

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