[PAGID] lymphopenia

[Michael Albert]

Neuropsychiatric abnormalities and lymphopenia would bring testing ADA
activity to my mind as it is an easy and relatively cheap test.
Just a shot in the dark, though.
Sincerely,
Michael

--
M.H. Albert, MD
Dr. von Haunersches Kinderspital der LMU
Lindwurmstr.4
80337 München
Germany

On Tue, Jan 6, 2009 at 5:49 PM, Sorensen, Ricardo <RSoren at lsuhsc.edu> wrote:


>  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

>




-- 
Dr. med. Michael Albert
Dr. von Haunersches Kinderspital der LMU
Lindwurmstr.4
80337 München
Tel 089-5160-2811
Fax 089-5160-7766
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