[CIS PIDD] Teen with immunodeficiency and recent onset ataxia
Notarangelo, Luigi
Luigi.Notarangelo at childrens.harvard.edu
Wed Jun 13 19:48:26 EDT 2012
Dock8? Eosinophilia, low IgM, high IgE would be consistent. Most patients have interagenic deletions that can be identified with array for CNV
Gigi Notarangelo
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Luigi D. Notarangelo, MD
Jeffrey Modell Chair of Pediatric Immunology Research
Division of Immunology
Children's Hospital Boston
Professor of Pediatrics and Pathology
Harvard Medical School
Karp Building, Room 10217
1 Blackfan Circle
Boston, MA 02115
Tel: (617)-919-2276
Fax: (617)-730-0709
On Jun 13, 2012, at 7:23 PM, "Church, Joseph" <JChurch at chla.usc.edu<mailto:JChurch at chla.usc.edu>> wrote:
Colleagues:
I will be seeing a 15yo Middle Eastern young man born to first cousins.
He has had chronic upper airway infections (H. influenzae and S. pneumoniae), recurrent presumed bacterial pneumonias, two year history of cervical adenopathy, and recent onset of ataxia. He has had recurrent purpuric skin rashes on lower extremeties that last for ~3days. Biopsies suggested "dermal hypersensitivity reaction” with negative immunofluoresence.
Vascular calcifications involving aorta, aortic arch were noted.
Ataxia was thought to be secondary to CNS calcifications (? confirmed)
Development is reportedly normal.
Limited labs available include the following:
WBC 10,700 with 37% eosinophils
CD4 332↓ IgG 21.1 g/L↑ Hepatitis and HIV screening negative.
CD8 18% IgA 6.19 g/L↑
CD19 892 IgM <0.1 g/L↓
NK 152 IgE 1200 u/ml↑
Mandibular mass biopsy: salivary gland with diffuse lymphocytic infiltrates.
I am unaware of any immunosuppressive therapy.
If this (rather incomplete) picture suggests any genetic syndrome, I would appreciate any help.
Thanks.
Joe Church
Children's Hospital Los Angeles
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