[CIS-PAGID] Patient with suspected CID and recurrent HPV infection

[Waleed Al-Herz]

 There are reports to use intalesional PPD, MMR, candidin for difficult to treat warts.The refernce below is an example  Dr. Waleed Al-HerzConsultant Allergist & Clinical Immunologist
Assistant Professor of PediatricsFaculty of MedicineKuwait UniversityKuwait
 Dermatol Ther. 2011 Jan-Feb;24(1):137-43. doi: 10.1111/j.1529-8019.2010.01388.x.

Intradermal injection of PPD as a novel approach of immunotherapy in anogenital
warts in pregnant women.

Eassa BI, Abou-Bakr AA, El-Khalawany MA.

PMID: 21276168  [PubMed - indexed for MEDLINE  

From: klaus.warnatz at uniklinik-freiburg.de
Date: Mon, 6 Feb 2012 18:47:29 +0100
To: pagid at list.clinimmsoc.org
Subject: [CIS-PAGID] Patient with suspected CID and recurrent HPV infection



Dear
Colleagues,We
are seeing a 32y old male patient of non-consanguineous German descendant, no
family history, with suspected combined immunodeficiency first diagnosis in
12/1995. He suffers from recurrent upper- and lower respiratory tract infections
(improved under Ig substitution), recurrent anal/perianal condylomata and
2xherpes zoster (2004 and 2010). Recurrent autoimmune thrombopenia 12/95,
cervical and abdominal lymphadenopathy, splenomegaly (EBV-, CMV-PCR negativ).
Histology lymphnode: reticular histiocytic granuloma, reactive hyperplasia,
polyclonal pattern, no sign of malignancy.The immune phenotyping showed
IgG (minimum 5.7, normal 7-16), low IgA and elevated polyclonal IgM (max 5.3g/l),
normal IgE serum levels, normal vaccination response to Td, low but detectable
anti PnPS. Elevated lymphoproliferative marker.White blood cell counts
3.6-4.9/nl (normal 4.3-10). All lymphocyte subpopulations are slightly low
including naïve CD4 (24% of CD4), normal gd T cells, normal T cell proliferation
after PHA and CD3/28, upregulation of CD40L slightly reduced (normal
upregulation of Cd25 and CD69), but no mutation in exons of CD40L detected. B
cells: low class switched B cells, increased CD21low and transitional B cells
(CD40 expression normal). Highly increased intravascular complement activation
(C3d of 19 (<9mg/dl) and CH50 of 13 (>20U/ml).ALPS diagnostics: dnTcells
3.5%, but normal Vit B12 and in vitro apoptosis.Bone marrow 1996: no signs of
myelokachexis, no further work up for WHIM.Currently,
the main problem are recurrent anal and perianal condylomata due to HPV 6 and 11
resistant to therapy with Imiquimod. After 7 operations no further operations
are possible without risking loss of sphincter function. Virudermin (topical
zink gel) was not well tolerated. An attempt of therapeutic HPV vaccination was
performed but did not show a lasting effect.Under
IgG replacement therapy no further infections of the respiratory tract.What
would be your recommendation for further diagnostic work up? And
especially what would be your recommendation for treatment of the recurrent HPV infection. Due to flares of AI
thrombopenia we were hesitant with systemic IFN therapy. How would you see the risk/benefit in this situation? Any antivirals? Cidofovir?So far no life threatening infection, so that we did not consider PBSCT at this time in a patient with unknown PID. What would be your criteria?I thank you for you helpWith best regards Klaus

Prof. Dr. med. Klaus Warnatz
UNIVERSITÄTSKLINIKUM FREIBURGUniversity Freiburg-Medical CenterCentre of Chronic ImmunodeficiencyDivision of Rheumatology and Clinical Immunology
Tel: +49-761-270-77640 / FAX -71000 / Pager: 12-7100
Breisacher Str. 117, 79106 Freiburg, Germanyklaus.warnatz at uniklinik-freiburg.dehttp://www.uniklinik-freiburg.de/cci


 		 	   		  
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