[CIS-PAGID] Problem Patient

[dmvascon at usp.br]

Hi Joe

I would look for Giardia and Campylobacter infections.

Giardia is a common offender of gastrintestinal tract in IgA deficient  
patients and causes diarrhea with cramps, difficult to diagnose on  
fecal specimens. It is necessary to get duodenal juice by endoscopy to  
improve the chances of diagnosis.

Campylobacter also causes diarrhea with cramps and sometimes bloody  
diarrhea. Hypogammaglobulinemic patients present prolonged elimination  
of the pathogen. Some patients present autoimmune manifestations  
secondary to Campylobacter infections (mainly neurological).

The food intolerances may be associated to mucosal destruction and  
secondary disaccharidase deficiency.

On the other hand, autoimmunity is rather common in adult IgA  
deficient patients, as well as gluten-sensitive enteropathy (without  
the typical IgA antibodies against transglutaminase etc) and Crohn's  
disease.

Best regards,

Dewton

Dewton de Moraes-Vasconcelos
University of Sao Paulo School of Medicine


Citando "Church, Joseph" <JChurch at chla.usc.edu>:


> 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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