[CIS-PAGID] question for increase liver enzyme in a pt with CVID

[YaeJean Kim]

Dear all,

I recently received a consultation on a 26 yo female who was diagnosed with
CVID and on monthly IVIG.
Her liver enzyme suddenly rose to 600/540 U/L (AST/ALT) last month. Her
liver ez had been normal before.


Additional hx:
She was also diagnosed with ulcerative colitis by GI people at other
institution (she has been f/u for GI issue at other place). -> She has been
on mesalazie for this.
She also received splenectomy at other hospital in 2008 -> for this she has
been on antibitc prophylaxis (first with augmentin, but stopped due to GI
problem, then swithced to 3rd generation cephalosporin, cefditoren more than
a year)
There is a hx of histiocytosis and bronchiectasis.
Hx of EBV associated multiple lymphadenopathy in the abdomen, in the neck,
mediastitum...(bx in 2009 showed EBV positive in a few cells *but
no*malignancy, no granuloma -> so no action was taken for LN issues
and her
condition appears stationary)
Recurrent intermitten parotitis and urticaria-> now ok for a while


When I saw her with increased liver ez at 632/628 (AST/ALT) in May 13,* I
discontinued the antibiotics first and the liver enzymes were still high at
622/540 after two weeks of antiboitc discontinuation.*
Her liver US in March 2011 showed mild hepatomegaly, still variable sizes of
LNs in the abdominal cavity (some increased, some decreased in sizes when
compared to previous ones).

During communication, I* found that she started VSL#3 for UC recommended by
her GI doctor at other instituion, a probiotics a month ago*. With that, she
reports that her bowel sx are improved.

Here are my questions that I hope to learn from you.

Do you usually use probiotics in patients with PID such as in this case and
associated inflammatory bowel disease presentation?
Any specific experience with probiotics in patients with CVID and UC?
Any comments or experience on particular aspects of VSL#3 in this setting?
Can this cause increase liver enzyme?

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
yaejeankim at skku.edu
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