[CIS-PAGID] Problem Patient

[Church, Joseph]

Colleagues
 
I follow a 50yo man with decades of the following:
     - "sinus" symptoms
     -  fatigue/fibromyalgia
     - "non-specific" colitis (pathology reports not available) with intermittent severe crampy pain and diarrhea
     - vitiligo
     - multiple food and drug intolerances (GI sx).
 
He recently developed dysuria with persistent burning despite normal UA and UC.
 
Laboratory studies have revealed the followijng:
     - IgG repeatedly normal (>1100)
     - IgA repeatedly undetectable
     - IgM repeatedly low (<30)
     - Normal T and B cell subsets
     - Normal antibody to tetanus toxoid
     - Absent responses to Pneumovax antigens
     - No lab evidence of autoimmune processes (negative ANA, ADNA, RF)
     - Normal thyroid function.
 
A 6-month trial of IVIG resulted in no benefit and was discontinued.
 
He is followed by a rheumatologist, gastroenterologist and urologist.
 
Could we be missing a chronic viral infection?
 
Any other suggestions?
 
Joe Church
Children's Hospital Los Angeles
     
     
 
 


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