[PAGID] X-linked CGD with meningitis

[Prof. Dr. Antonio Condino Neto]

The CSF shows 93% neutrophils and high protein !

I would consider a bacterial cause and treat it.

I do not agree this could be IFN-gamma side effect.

-- 
Antonio Condino-Neto
Professor, Department of Immunology
Institute of Biomedical Sciences, University of São Paulo
1730 Lineu Prestes Avenue, São Paulo - SP. ZIP 05508-000. Brazil
Tel (55) (11) 3091-7387 / Fax (55) (11) 3091-7224



Citando Christine Seroogy <cmseroogy at pediatrics.wisc.edu>:


> 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

>

>

>

>




----------------------------------------------------------------
This message was sent using IMP, the Internet Messaging Program.