[PAGID] Recurrent, vesicular eruption on forehead

[fabrício prado monteiro]

Hi,the evaluation of NK was fully investigated?

Did you consider Nk defects?

F!

On 5 May 2010 08:54, Berger, Melvin <Melvin.Berger at uhhospitals.org> wrote:


> This sounds possibly analogous to the situation with vaccinia. Past history

> of eczema is considered a contra-indication, even if not active and no

> present topical treatment with steroids or calcineurin antagonists.  You say

> negative DHS candida skin test- was he positive for DTH to another antigen ?

>

> Melvin Berger, M.D., Ph.D.

> Adjunct Professor of Pediatrics and Pathology

> Case Western Reserve University

> Cleveland, OH 44106

>

> ________________________________

>

> From: pagid-bounces at list.clinimmsoc.org on behalf of

> Colin_Freccia at Rush.Edu

> Sent: Tue 5/4/2010 11:48 AM

> To: pagid at list.clinimmsoc.org

> Subject: [PAGID] Recurrent, vesicular eruption on forehead

>

>

>

> 17YO Caucasian male with a painful, recurrent, vesicular cutaneous eruption

> (HSV-1 positive by PCR on multiple occasions, VZV not detected) involving

> the forehead only.  Since January 2009 he has had 7-8 localized recurrences

> despite suppressive doses of valacyclovir, taken as directed, and severe

> post-herpetic neuralgia requiring pain management and a recent trigeminal

> nerve block.  The only known risk factors are moderate-to-severe eczema as a

> young child, resolved, with residual xerosis; uncomplicated chickenpox in

> early childhood, and aseptic meningitis without sequela at age 10; otherwise

> healthy, without genital herpes.  No family history of similar illness or

> immune deficiency disease.

>

>

>

> Pertinent laboratory tests:

>

> - CBC:  WBC 5000/mcL, absolute neutrophils 2000, lymphocytes 1580,

> monocytes 440, eosinophils 870 and basophils 40

>

> - quantitative IgGAM all normal; IgE 3200 U/L

>

> - negative HIV antibody screen

>

> - lymphocyte flow cytometry immunophenotyping:  ALC 1269 (1140-4430/mcL),

> CD19+ 203 (34-1019), CD3+ 964 (638-3721), CD4+ 546 (364-2659), CD8+ 381

> (239-1728) and CD56+ 38 (23-797)

>

> - in vitro PBMC mitogen stimulation:  slightly low responses to PHA and

> PWM, low to ConA

>

> - anergy to candida DHS skin test

>

> Has anyone had a similar case or cases and what you would recommend re:

>  Dx, Rx and further work-up?  Also, can anyone assist with in vitro

> stimulation of PBMC using HSV-1/2 and possibly VZV vs. a reference Ag such

> as tetanus toxoid?  Thank you.

>

>

> --

> Colin Freccia, MD - Fellow

> Section of Allergy/Immunology

> Department of Immunology/Microbiology

> Rush University Medical Center

>

>

>

> Visit us at www.UHhospitals.org.

>

> The enclosed information is STRICTLY CONFIDENTIAL and is intended for the

> use of the addressee only. University Hospitals and its affiliates disclaim

> any responsibility for unauthorized disclosure of this information to anyone

> other than the addressee.

>

> Federal and Ohio law protect patient medical information, including

> psychiatric_disorders, (H.I.V) test results, A.I.Ds-related conditions,

> alcohol, and/or drug_dependence or abuse disclosed in this email. Federal

> regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and

> 3701.243 prohibit disclosure of this information without the specific

> written consent of the person to whom it pertains, or as otherwise permitted

> by law.





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

CRM-DF12270 CRM-GO11928

 Hospital Regional da Asa Sul.
               (HRAS)

 Hospital das Forças Armadas.
                (HFA)

Centro Clínico Sudoeste SALA 248
          ENDOPED

        Fone 3361 1601
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://seven.pairlist.net/mailman/private/pagid/attachments/20100506/30d09983/attachment.htm>