[PAGID] X-linked CGD with meningitis

[fabrício prado monteiro]

If you think of chronic meningitis, ask the complement proteins, MAC (C8 and
C9)?

It can be an adverse effect of IFN associated, have evaluated it?

Success!

2009/12/2 John Ziegler <j.ziegler at unsw.edu.au>


> -

>  We had a young adult with CGD who presented with chronic basal

> meningitis, probably meningococcal.

>

>  ------------------------------

> *From:* pagid-bounces at list.clinimmsoc.org [mailto:

> pagid-bounces at list.clinimmsoc.org] *On Behalf Of *Christine Seroogy

> *Sent:* Wednesday, 2 December 2009 5:11 AM

> *To:* pagid at list.clinimmsoc.org

> *Subject:* [PAGID] X-linked CGD with meningitis

>

> Dear Colleagues,

>

> I would appreciate your input on a 6 y/o boy with X-linked CGD who

> presented with  headache (no meningismus signs on presentation),

> intermittent fever and generally not feeling well for 3 days.

>

> He has been managed with IFN-g 3x/wk, itraconazole and bactrim prophylaxis.

>

> He was diagnosed at age 2 when he presented with aspergillus pna—this was

> successfully treated with one year of antifungals.  He has had problems with

> granulomatous disease in his GI/GU tract over the past 2 years.

>

> He lives on a farm in WI, however the family tries to remain vigilant about

> exposures.

>

> He was admitted for further eval; during second hospital day he developed

> severe headache and meningismus signs:

>

> Head CT normal

> Chest/abdomen CT: RUL pneumonia

> CSF leukocytosis: 2238 WBCs/ul; 25 RBCs/ul 93% PMNs Protein 54 (15-45)

> glucose normal.

> ESR 42 CRP 6

> Peripheral blood WBC with mild leukocytosis

>

> Blood culture (prior to antibiotics) grew S. viridans in 20 hours (felt to

> be contaminate)

> CSF culture negative, however tap occurred 24 hours after initiation of

> antibiotics.

>

> He has been on chronic low-dose steroids because of his granulomatous

> disease and was given stress-dosing on admission which was temporally

> related to relief of headache.

>

> He also had improvement of signs and symptoms after LP.

>

> He has had worsening of his headache in the last 24 hours despite

> broad-spectrum antibiotics (and decrease in steroid dose to baseline—5 mg

> QOD).  He is scheduled for head MRI with contrast today.

>

> I am wondering if anyone has seen  a similar presentation?  We are

> concerned about granulomatous disease in the CNS and currently do not have

> an identified pathogen.  The next step will be lung tissue since the

> processes are likely unified.

>

> Thank you for any comments or input.

>

> Regards,

>

> Chris

>

>

> --

> Christine M. Seroogy MD, FAAP, FAAAAI

> Assistant Professor

> University of Wisconsin

> Department of Pediatrics

> Division of Allergy, Immunology & Rheumatology

> 1111 Highland Avenue

> 4139 WIMR

> Madison, WI  53705-2275

> phone: 608-263-2652

> fax: 608-265-9721

>

>

>



-- 
Dr. Fabrício Prado Monteiro.
  Imunologista - Pediatra.

CRM-DF12270 CRM-GO11928

          HMIB/HRAS.

Centro Clínico Sudoeste SALA 248
          ENDOPED

Fone 3361 1601
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