[CIS-PAGID] Problem Patient

[Routes, John]

have you excluded celiac disease?

John M. Routes, MD
Chief, Section of Allergy and Clinical Immunology
Professor of Pediatrics, Medicine, Microbiology and Molecular Genetics
Department of Pediatrics
Children's Hospital of Wisconsin
Medical College of Wisconsin
9000 W. Wisconsin Ave.
Milwaukee, WI  53226-4874

Phone: 414-456-4802; 414-266-6997
Fax: 414-456-6487 (Clinical)
Fax: 414-456-6323 (Laboratory)
Email: jroutes at mcw.edu




________________________________
From: "Church, Joseph" <JChurch at chla.usc.edu>
Reply-To: "pagid at list.clinimmsoc.org" <pagid at list.clinimmsoc.org>
Date: Sat, 24 Sep 2011 15:40:26 -0500
To: "pagid at list.clinimmsoc.org" <pagid at list.clinimmsoc.org>
Subject: [CIS-PAGID] Problem Patient

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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