[CIS-PAGID] Problem Patient

[Donald Cuong Vinh, Dr]

Have you done a ureaplasma/mycoplasma culture on his urine, as a cause of non-gonococcal urethritis causing dysuria? However, it would not explain his GI symptoms/"colitis", and the path reports or repeat biopsy/stool work-up may be key for that.

Don





Donald C. Vinh, MD
Assistant Professor
Division of Infectious Diseases,
Division of Allergy & Clinical Immunology
Dept of Medicine; Dept of Medical Microbiology; Dept of Human Genetics
McGill University Health Centre - Montreal General Hospital
1650 Cedar Ave, Rm A5-156
Montreal, Quebec,  Canada H3G 1A4
Ph: 514-934-1934 x42419 (office); x42811 (admin assist)
Fax: 514-934-8423
e-mail: donald.vinh at mcgill.ca



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________________________________
From: pagid-bounces at list.clinimmsoc.org [pagid-bounces at list.clinimmsoc.org] on behalf of Church, Joseph [JChurch at chla.usc.edu]
Sent: Saturday, September 24, 2011 4:40 PM
To: 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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