[CIS-PAGID] Puzzling Patient #1

[Richard Wasserman]

Any other history of infection?
Richard Wasserman
Dallas

On Wed, May 2, 2012 at 8:47 PM, Church, Joseph <JChurch at chla.usc.edu> wrote:


>  This 18yo girl had persistent anterior cervical adenitis complicating

> severe purulent tonsillitis.  Throat culture was negative for bacterial

> pathogens.  Routine serology for EBV and CMV were negative.  There was no

> organomegaly or adenopathy other than that described.****

>

> ** **

>

> Eventually she came to biopsy that showed necrotizing adenitis with strong

> histochemical staining for EBV.  Histologic and histochemical features were

> not consistent with neoplasm.****

>

> ** **

>

> EBV serology 1 month after the procedure showed only +EBV VCA IgM; 3

> months after the procedure the serologic picture was the same.  ****

>

> ** **

>

> Blood PCR for EBV was negative x2.****

>

> ** **

>

> The following immune functions were *normal*:****

>

>             T-, B-, NK cell numbers.****

>

>             Ig levels ****

>

>             Antibody responses to Pneumovax****

>

>             Mitogen and antigen-specific LPAs****

>

>             CTL function (Cincinnati Children's Lab)****

>

>             NK cell function (Cincinnati Cildren's Lab)****

>

>             X-inactivation - random (looking for potential for XLP)****

>

> ** **

>

> Have any of you seen 4+ EBV in a lymph node with negative VCA IgG and EBNA

> and negative blood EBV PCR? ****

>

> ** **

>

> What am I missing?****

>

> ** **

>

> Joe Church****

>

> Children's Hospital Los Angeles****

>

>

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-- 
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211
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