[CIS-PAGID] Duration of treatment for Crohn's in XLA

[Richard Wasserman]

I my patient the pathology clearly looks like Crohn's. The onset was more
clearly post-infectious than is common for Crohn's I think. It may be
something else.
Richard

On Fri, Apr 8, 2011 at 11:14 AM, Jack Bleesing <Jack.Bleesing at cchmc.org>wrote:


> Question out of relative ignorance! Why the surprise? Is Crohn's purely an

> autoimmune disease in the "classical" sense? And is it really Crohn's

> disease in the classical sense?

>

> J

> -----Original Message-----

> From: "Charlotte Cunningham-Rundles at mssm.edu" <

> charlotte.cunningham-rundles at mssm.edu>

> To: PAGID <pagid at list.clinimmsoc.org>

> To: Kate <sullivak at mail.med.upenn.edu>

>

> Sent: 4/8/2011 12:10:04 PM

> Subject: Re: [CIS-PAGID] Duration of treatment for Crohn's in XLA

>

> I was surprised too --- and have a good number of older ones!  It would be

> a

> neat question and could be answered!

>

>

> On 4/8/11 12:03 PM, "Kate" <sullivak at mail.med.upenn.edu> wrote:

>

> > I don't know if you are looking for research projects but you could

> easily

> > query the USIDNET registry and add all the patients that have been

> discussed

> > on PAGID.  Maybe I was the only one surprised but I suspect not.

> >

> > Kate

> > On Apr 8, 2011, at 11:59 AM, Brian P Vickery wrote:

> >

> >> Kate, I was surprised to find autoimmunity in two of our XLA patients at

> >> Duke. I assumed the care of two young men, one in his early twenties,

> and one

> >> in his thirties, both of whom have XLA and ESRD due to an a

> immune-mediated

> >> kidney lesion like FSGS but with nonspecific pathology. The older one

> also

> >> had a very aggressive form of granulomatous Crohn's-like gut

> inflammation

> >> which had been treated with surgical resection in the past and more

> recently

> >> TNF inhibition.

> >>

> >> FWIW.

> >> ___________________

> >> Brian Vickery, MD

> >> Division of Pediatric Allergy & Immunology

> >> Duke University Medical Center

> >> DUMC Box 2644, Durham NC 27710

> >> 919.681.2949

> >>

> >> "Email should NOT be used for urgent medical issues. The information in

> this

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> >> addressee(s). Any other person, including anyone who believes he/she

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> >> shared unless in compliance with Duke Medicine policies on

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> >> and/or with the approval of the sender."

> >>

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

> >>

> >>> To: pagid at list.clinimmsoc.org

> >>> From: Kate Sullivan <sullivak at mail.med.upenn.edu>

> >>> Sent by: pagid-bounces at list.clinimmsoc.org

> >>> Date: 04/06/2011 05:54PM

> >>> Subject: Re: [CIS-PAGID] Duration of treatment for Crohn's in XLA

> >>>

> >>> I don't know the answer to your question and was surprised by the

> question.

> >>> I think of XLA as being more free from autoimmune disease than other

> immune

> >>> deficiencies.  I wonder how common this is and wonder if this is

> perhaps a

> >>> topic for some research investigation.

> >>>

> >>> Kate

> >>> Kate Sullivan, MD PhD

> >>> Professor of Pediatrics

> >>> ARC 1216 Immunology CHOP

> >>> 3615 Civic Center Blvd.

> >>> Philadelphia, PA 19104

> >>> (p) 215-590-1697

> >>> (f) 267-426-0363

> >>>

> >>>

> >>> On Apr 6, 2011, at 5:27 PM, Richard Wasserman wrote:

> >>>

> >>>> > I have cared for this 23yo with XLA (BTK mutation confirmed) who has

> a

> >>>> ten year history of Crohn's. He has been maintained on azathioprine

> and has

> >>>> never been exposed to a biologic response modifier. When azathioprine

> was

> >>>> weaned about five years ago there was relapse. He has been doing very

> well

> >>>> since his remission was reinduced with prednisone. He now asks about

> >>>> stopping azathioprine. He has never had any other autoimmune

> diathases. Is

> >>>> there any experience with discontinuing treatment in XLA patients with

> >>>> Crohn's?

> >>>> > Thanks,

> >>>> > Richard Wasserman

> >>>> > Dallas

> >>>> >

> >>>> > --

> >>>> > Richard L. Wasserman, MD, PhD

> >>>> > DallasAllergyImmunology

> >>>> > 7777 Forest Lane, Suite B-332

> >>>> > Dallas, Texas 75230

> >>>> > Office (972) 566-7788

> >>>> > Fax (972) 566-8837

> >>>> > Cell (214) 697-7211

> >>>

> >>

> >

> > Kate Sullivan, MD PhD

> > Professor of Pediatrics

> > ARC 1216 Immunology CHOP

> > 3615 Civic Center Blvd.

> > Philadelphia, PA 19104

> > (p) 215-590-1697

> > (f) 267-426-0363

> >

> >

> >

>

>

>



-- 
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211
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