[CIS-PAGID] Problem Patient

[YaeJean Kim]

Dear Dr. Church,

You might also want to check rotavirus, norovirus or pathogens
like microsporidia, cryptosporidia, isosproa..just in case (or to complete
your evaluation).  For rota or norovirus, I have seen chronic infection in
mainly stem cell recipients (they are children, though)...maybe not the case
in this pateint but can be the cause of occasional bad episode of GI
probems..

Pathogens like microsporidia, cryptosporidia, isosproa are mostly reported
in HIV/AIDS patients but can be the cause of intractable cause of chornic
diarrhea in certain patients with immunodeficieny in recent reports...

I think Giardia is also a good thinking. Dueodenal biopsy or string test can
be tried.

I also wonder whether this patient has eosinophilic gastroenteritis in
addition to his underlying condition....eosinophilic gastroenteritis usually
present with eosinophilia but certain pateints only have increased
infiltration of eosinophils in the GI tract without obvious blood
eosinophilia.

YaeJean
-- 
Yae-Jean Kim, MD
Assistant Professor
Division of Infectious Diseases
Department of Pediatrics
Sungkyunkwan University School of Medicine
Samsung Medical Center
50 Irwon-dong Gangnam-gu
Seoul, Korea
Tel)  +82-2-3410-0987  Fax) +82-2-3410-0043
yaejeankim at skku.edu


On Sun, Sep 25, 2011 at 8:02 AM, Donald Cuong Vinh, Dr <
donald.vinh at mcgill.ca> wrote:


>

> 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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