[CIS-PAGID] peritonitis in a PD patient

[Jyonouchi, Soma C]

Any problems mounting fevers or elevations of inflammatory markers?  I typically also think of TLR pathway defects (IRAK4, MyD88, NEMO) with disseminated gram+ve and -ve organisms.  A TLR assay may be useful.

Best,

SJ

From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Richard Wasserman
Sent: Monday, June 20, 2011 9:53 AM
To: PAGID
Subject: [CIS-PAGID] peritonitis in a PD patient

I have been asked to evaluate a two year old who has been on peritoneal dialysis since 12 days of age because of recurrent peritonitis with unusual organisms. Cultures have grown Xylosoxidans, gamma hemolytic strep, pseudomonas, strep viridans, strep pneumoniae, group b strep, staph aureus. Most recently, the staph aureus peritonitis disseminated and he had an associated osteomyelitis of the knee and several inflammed lymph nodes one of which grew staph aureus on biopsy. He has never had sinusitis, pneumonia or a cutaneous abscess. There have been a few episodes of otitis media.

IgA [H] 126 mg/dL (24-121), IgG 846 mg/dL (533-107), IgM 73 mg/dL (26-218). Neutrophil oxidative burst assay showed 94% of cells positive (transport control was 83%).

I'd don't know that there are additional tests that will contribute. Suggestions?
Thanks,
Richard Wasserman

--
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
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://seven.pairlist.net/mailman/private/pagid/attachments/20110620/dd815d71/attachment.htm>