[CIS-PAGID] liver abscess and aortitis?

[John Ziegler]

-

YaeJean
 
Have you seen the DHR plot yourself? We have seen AR CGD DHR misreported as
normal.
 
I'm not familiar with the units but any detectable serum IgA in a 4 m old
is normal in our lab. At the nadir, 2.5 g/L is not very low.
 
We follow a teenager with CMCC who has aortic calcification. It's
interesting to wonder whether she had aortitis in early infancy.
 
John
 
 
A/Prof. John B. Ziegler, MD, FRACP
School of Women's & Children's Health, University of NSW 
C/o Department of Immunology & Infectious Diseases 
Sydney Children's Hospital 
High St., Randwick NSW 2031 
Australia 
T: (02) 93821515 
F: + 61 + 2 93821580 
E: j.ziegler at unsw.edu.au 


  _____  

From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-
bounces at list.clinimmsoc.org] On Behalf Of ???
Sent: Wednesday, 13 October 2010 12:22 PM
To: pagid at list.clinimmsoc.org
Subject: [CIS-PAGID] liver abscess and aortitis?



Dear All,

 

Thanks a lot for my previous question regarding IVIG in agammaglobulinemia
pt. He is receiving high dose intravenous Ig and still hanging in there. 

 

I now have another question about this 4 month old boy who has been treate
with antibiotics for more than 2 months...

Sorry but the story is a little long..

----------------------------

. previously healthy, no obvious family hx (except his dad had IgA
nephropathy) or pre/perinatal hx

. at 2 mo of age, developed fever and diagnosed with UTI d/t Enterobacter

. started antibiotics and abdominal US revealed multiple liver abscesses
and aortitis (infiltrative thickening around abdominal aorta)

 

. referred to me (at that time, no fever and stable condition), I started
meropenem..no fever but persistent leukocytosis (lympho dominant) over
20x10^3

. continued Abt for 3 more weeks, little changes for liver abscesses and
aortitis (checked multiple times by US, and liver MRI)

. suddenly liver enzyme increased, no fever still -> discontinued
antibiotics in fear of Abt side effect and I started to suspect other
possibilities such as liver mass (at that time slightly high alpha
fetoprotein) in addition to abscess..

. at this point, we did liver biopsy -> negative culture and negative
bacterial PCR, pathlogy told typical for abscess

. by the time after bx and pathology report came out, it was around 2 week
off from antibiotics, he developed fever again and leukocytosis

 

. I started meropenem again (normla liver ez at this time), continued mero
for 4 wks until yesterday..

 

A f/u liver MRI showed that there is no abscess left...

I plan to discontinue meropenem...but what shall I do about this aortitis?
I am not sure whether this was incidental finding or in fact this child had
infectious, septic phlebitis of the aorta..

 

Anyway, he has low IgA and I am going to f/u this IgA level. 

DHR: normal

IgG (Immunoglobulin G)                   ㎎/㎗     252                
IgA (Immunoglobulin A)                   ㎎/㎗     5                  
IgM (Immunoglobulin M)                   ㎎/㎗     58                 
IgE (Immunoglobulin E)                   IU/㎖     3.3      

C3 231, C4 26, CH50 53

FANA (-), ANCA (-), VDRL (-), HIV (-), Toxoplasma (-)

Echo: normal

----------------------------------------------------------------

So, my questions are

Anybody has advice or experience with Ig A def and liver abscess and
aortitis?

One time IgA less than 5 is suffieicent to diagnose IgA deficiency?

Additional tests to do? What is this aortitis? any immune deficiency with
aortitis? 

 

Thanks a lot in advance.

YaeJean 

 

 

 

 

 

 




 

--------------------------------------------------------------------------

Yae-Jean Kim, MD

Assistant Professor

Division of Infectious Diseases

Department of Pediatrics

Sungkyunkwan University School of Medicine

Samsung Medical Center

50 Irwon-dong Gangnam-gu

Seoul, Korea


Tel)  +82-2-3410-0987 

Fax) +82-2-3410-0043



  _____  

보낸사람: "Church, Joseph" [JChurch at chla.usc.edu]
받는사람: pagid at list.clinimmsoc.org
날 짜: 2010년 9월 29일(수) 23:00:14
제 목: Re: [PAGID] intraventricular IVIG

  

The only medication that had been proposed for enteroviral infection was
pleconaril, but I don’t know if it is available anywhere.  We have not
used intraventricular IVIG.

 

Joe Church

Childrens Hospital Los Angeles

 

  _____  

From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-
bounces at list.clinimmsoc.org] On Behalf Of ???
Sent: Tuesday, September 28, 2010 5:50 PM
To: pagid at list.clinimmsoc.org
Subject: [PAGID] intraventricular IVIG

 

Dear all,

 

I have a 20 year-old agammagloulinemia pt who came down with chronic
enterovirus meningoencephalitis. 

The pt has been on multiple antibiotics, dexamethasone, and Tb medication
already several months...in other hospital. 

 

Anybody has an advice on intraventricular IVIG?  how about antiviral agent?
Thanks in advance

 

YaeJean

--------------------------------------------------------------------------

Yae-Jean Kim, MD

Assistant Professor

Division of Infectious Diseases

Department of Pediatrics

Sungkyunkwan University School of Medicine

Samsung Medical Center

50 Irwon-dong Gangnam-gu

Seoul, Korea

Tel)  +82-2-3410-0987 

Fax) +82-2-3410-0043

 

 
<http://mail.skku.edu/servlet/CheckRead?key=1285721405132&folderID=yaejeanki
m at skku.edu:002outbox&db=CRINITY&table=CRMAIL&outBoxSEQ=&rcpt=pagid at list.clin
immsoc.org&rcpt=pagid at list.clinimmsoc.org> 


---------------------------------------------------------------------
CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, 
is for the sole use of the intended recipient(s) and may contain
confidential
or legally privileged information. Any unauthorized review, use, disclosure
or distribution is prohibited. If you are not the intended recipient, please
contact the sender by reply e-mail and destroy all copies of this original
message. 
---------------------------------------------------------------------


 
<http://mail.skku.edu/servlet/CheckRead?key=1286932947335&folderID=yaejeanki
m at skku.edu:002outbox&db=CRINITY&table=CRMAIL&outBoxSEQ=> 

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://seven.pairlist.net/mailman/private/pagid/attachments/20101013/f985cbb2/attachment.htm>