[PAGID] X-linked CGD with meningitis

[Sabiha Anis]

I would agree with professor Antonio, but relief of headache after steroids and LP might suggest other posiibilities. may be you should also rule out cryptococcal menigitis.

 

Sabiha

Clinical Immunologist

Sindh Institute of urology and Transplantation (SIUT)

Karachi, Pakistan
 

> Date: Wed, 2 Dec 2009 14:56:52 -0200

> From: condino at icb.usp.br

> To: pagid at list.clinimmsoc.org; cmseroogy at pediatrics.wisc.edu

> CC: pagid at list.clinimmsoc.org

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

> 

> 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

> >

> >

> >

> >

> 

> 

> 

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