[CIS-PAGID] question for CGD

[John Ziegler]

YaeJean

Is the baby receiving corticosteroids? The intense inflammatory component of CGD also need to be treated.

John


A/Prof. John B. Ziegler
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, 16 February 2011 12:30 PM
To: pagid at list.clinimmsoc.org
Subject: [CIS-PAGID] question for CGD


Dear all,



I have a question about a 4 month old boy who is in our PICU now.



This baby was transferred to our center for an evaluation of tumor in the liver (r/o hepatoblastoma) on Friday (2/12).

Actually he was on the H-O ward when I saw hims Monday morning. But as soon as I heard that his liver abscess grew Serratia at previous hospital (they did open liver biopsy and culture) I sent out respiratory burst test and diagnosed CGD on Monday evening (2/14).



He has huge mas like abscess in the liver, pleural effusion, multiple lung nodules with massive irregular pulmonary infiltration... He was stable until Tuesday morning (while we were discussing options for surgical intervention such as abscess drainage and diagnositc biopsy for additional pathogen), he suddenly developed tachypnea on Tuesday morning (2/15).

He is now in PICU and got intubated with chest tube for pleural fluid drainage since last night.



He has been on meropenem for Serratia from previous hospital but I started antifungal agent (Amphotericin, I prefer Vori but insurance will not cover at this point) right after I saw the chest CT.

And in addition, because in Korea we give BCG and birth, I also started anti-Tb medication (INH+RFP+EMB) in fear that he might have disseminated BCG infection as well, esp his lung condition deteriorates and I saw massive mediastinal LNs enlargements with necrotic portions in them...



Tons of tests were sent from blood, CSF, pleural fluid, tracheal aspiration (for bacteria, fungus, TB...).  our pulmonologist couldn't do BAL on this child since he is too small for BAL.



At this point he is critical but somewhat stable in PICU. Is there anything that I can do for this baby? Should I add  cytokine?

If the condition continues to be stable, should I persuade my surgeons and do the biopsy and drainage from the lung, mediastinum and liver?



Obviously, the diagnosis was delayed from another hospital and since I saw this child his condition just deteriorated so fast within 24 hours.

I will appreciate any advice and suggestion. Thanks a lot!!!  and wish him a good luck!



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=1297819781974&folderID=yaejeankim@skku.edu:002outbox&db=CRINITY&table=CRMAIL&outBoxSEQ=&rcpt=pagid@list.clinimmsoc.org]
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://seven.pairlist.net/mailman/private/pagid/attachments/20110216/e7b27b98/attachment.html>