[CIS-PAGID] Adult with recurrent "Zoster"

[Riedl, Marc]

Joe,

I've see one similar case but testing demonstrated very low VZV-specific LPA responses in an otherwise immunocompetent individual. He's been fairly successfully maintained on Valtrex prophylaxis.
Related, recently saw a case of localized recurrent CMV corneal endothelilitis with very low CMV-specific LPA responses in an otherwise immunocompetent gentleman.

Best,

Marc

Marc Riedl, M.D., M.S.
Assistant Professor of Medicine
Section Head, Clinical Immunology and Allergy
UCLA - David Geffen School of Medicine
10833 Le Conte Ave, 37-131 CHS
Los Angeles, CA  90095-1680
Tel 310.206.4345  Fax 310.267.0090



From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Church, Joseph
Sent: Thursday, December 30, 2010 7:18 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS-PAGID] Adult with recurrent "Zoster"

Thanks, Mel.

Has anyone had a similar case?

Joe Church

________________________________
From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Berger, Melvin
Sent: Wednesday, December 29, 2010 10:27 PM
To: pagid at list.clinimmsoc.org
Subject: RE: [CIS-PAGID] Adult with recurrent "Zoster"

1. Good old-fashioned DTH skin tests.  2. T-cell response by Elispot to autologous cells infected with VZV - see what cytokines he makes compared to controls. 3. TLR responses. 4. Reminders to take his prophylaxis.

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 Church, Joseph
Sent: Wed 12/29/2010 7:09 PM
To: pagid at list.clinimmsoc.org
Subject: [CIS-PAGID] Adult with recurrent "Zoster"
Colleagues:

A 57yo man was referred for recurrent Herpes zoster.   Lesions have recurred ~ 2 times a year for 20 years.  They affect the same facial location (right ear).  Outbreaks are associated with increased stress and missing Valtrex prophylaxis.  He has absolutely no other infectious history and is otherwise healthy.

NORMAL laboratory findings include the following:

 *   CBC, CMP, sed rate, CRP
 *   IgG, IgA, IgM
 *   Antibody responses to tetanus, hepatitis A and Pneumovaxtm
 *   T, B and NK numbers
 *   PHA and PWM LPAs
 *   Tetanus, Candida and VZV LPAs
 *   NK cytotoxicity (Cincinnati Children's)
 *   CTL cytotoxicity (Cincinnati Children's)

Other than the possibility that these episodes are not VZV-related, does anyone have any other ideas?

Joe Church
Children's Hospital Los Angeles



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