[PAGID] Recurrent, vesicular eruption on forehead

[Sorensen, Ricardo]

If you are at the endo of the rope treatment-wise, try high doses of
vitamin D. There is a nice  review in JACI 2008; 122; 261-6. We have had
some miracle effects with high dose Vit D although never in a patients
like this

Ricardo Sorensen


________________________________

From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of
Colin_Freccia at Rush.Edu
Sent: Friday, May 07, 2010 8:34 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] Recurrent, vesicular eruption on forehead


On behalf of our Section of Allergy/Immunology at Rush, a BIG thank you
to all who took the time to reply to this case.  I emailed all of the
replies individually to cut down on filling everyone's in-box.  Should
you have any more suggestions or questions re: this case, please feel
free to email me at colin_freccia at rush.edu.  
 
Once again, thank you for your interest in this case.
 
Sincerely,
Colin
 
--
Colin Freccia, MD - Fellow
Section of Allergy/Immunology
Department of Immunology/Microbiology
Rush University Medical Center


-----pagid-bounces at list.clinimmsoc.org wrote: -----



	To: pagid at list.clinimmsoc.org
	From: Colin_Freccia at rsh.net
	Sent by: pagid-bounces at list.clinimmsoc.org
	Date: 05/04/2010 10:48
	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.

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