[CIS-PAGID] peritonitis in a PD patient

[Richard Wasserman]

Each episode cultures a single organism and one episode was clinical and
culture negative. I have only been with the family for 30minutes but I got
no signals for psychiatric concerns.
Richard

On Mon, Jun 20, 2011 at 2:30 PM, Howard Lederman <hlederm1 at jhmi.edu> wrote:


>

>

> "Conley, Mary Ellen" <maryellen.conley at STJUDE.ORG> wrote:

>

>

>

> Something smells a little fishy.  Does the child have multiple organisms at

> the same time?  I would worry about some kind of fistula or Munchausen by

> proxy.

> Mary Ellen

>

>

>

>

>

>

> Mary Ellen Conley, MD

> Department of Immunology/ Mail Stop 351

> St. Jude Children's Research Hospital

> 262 Danny Thomas Place

> Memphis, TN 38105-3678

> FAX  901-595-3977

> TEL  901-595-2576

>

>

>

> ________________________________

> From: pagid-bounces at list.clinimmsoc.org [mailto:

> pagid-bounces at list.clinimmsoc.org] On Behalf Of Richard Wasserman

> Sent: Monday, June 20, 2011 11:58 AM

> To: pagid at list.clinimmsoc.org

> Subject: Re: [CIS-PAGID] peritonitis in a PD patient

>

> He has a normal inflammatory response with fever and leukocytosis. I was

> thinking about TLR pathways but the absence of any other infections was a

> question.

> Richard Wasserman

>

> On Mon, Jun 20, 2011 at 8:57 AM, Jyonouchi, Soma C <

> JYONOUCHI at email.chop.edu<mailto:JYONOUCHI at email.chop.edu>> wrote:

> 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> [mailto:

> 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<tel:%28972%29%20566-7788>

> Fax (972) 566-8837<tel:%28972%29%20566-8837>

> Cell (214) 697-7211<tel:%28214%29%20697-7211>

>

>

>

> --

> 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

>

> ________________________________

> Email Disclaimer: www.stjude.org/emaildisclaimer

>




-- 
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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