[CIS PIDD] autoimmune disorder

[Wilmer Cordova Calderon]

Writing and attached information for a case that has no definite diagnosis
and appeal to their experience in patients with autoimmune background and
perhaps a primary immunodeficiency disorder.

In our medical board concluded that it biopsiará kidney, skin and pulse
methylprednisolone is used in addition use of gamma globulin
(immunomodulatory)

If you have suggestions I am ready to discuss them well with my colleagues

Thank you for your response and time

Atte

Wilmer Cordova

Allergy immunology

Lima Peru


Case Report

*I. PATIENT INFORMATION*

AGE: 1 year 2 months

SEX: Female

SERVICE: Infectious Diseases

* *

*II. REASON FOR ADMISSION*

2 weeks episodes of rising thermal unquantified PAPULOERITEMATOSAS INJURY
IN FACE AND IN TRUNK, productive cough and weakness. Increase
papuloeritematosas lesions predominantly on face and trunk, liquid stools s
/ ms / s (submitted), lesions erythematous in oral cavity and gums.
Hospitalization for persistent febrile episodes.

*III. BACKGROUND:*

*- PERSONAL:*

Hospitalized

Dx 06/03/2012: Sd febrile Sd  edematous, Sd peural, Diffuse Liver Disease
 Acute mucocutaneous candidiasis, Erythema Multiforme, Hemolytic Anemia.DC
child LES, DC congenital immunodeficiency.

*LAB EXAMS:*

PCR 4,

Clumps Tifico O 1/320 Tifico H 1/40

Ex Urine: 2-3 Leuc xc, Protein +, RBC 4-6xc

TORCH IgM Toxoplasma 12.87,

C3 40, C4 8

FR 23.8

ANA 1/320, Anti native DNA +, T Coombs + Ret 4%

IMAGES:

Eco Abd: Hepatomegaly, nephromegaly mild bilateral renal inflammatory
process.

Rx thorax mild left pleural effusion.

TREATMENT: Methylprednisolone, Prednisone 08/04/12 to 06/07/12 2mg/K/d of.



*IV. PHYSICAL EXAMINATION OF INCOME:*

Pale, with TCSC increased Cushinoide facies, erythematous papulopustular
lesions on the face and trunk

DRCD hepatomegaly to 4 cm.



*V. EVOLUTION*

Get as treatment: Dexamethasone 2 mg c/8h, Azithromycin 100 mg C/24 h,
Sucralfate 150 mg w / 6 h, Ranitidine 20 mg every 12 h



*VI. DIAGNOSIS:*

1. Persistent Fever Syndrome

2. DC Acute Toxoplasmosis

3. DC Autoimmune Disease: Systemic Lupus Erythematosus Child

4. Congenital immunodeficiency vs. Primary

5. Exogenous Cushing syndrome.



*VII. AUXILIARY TESTS:*

CBC                       (07/07/2012)                     (13/07/12):

Leukocytes        11000                                   8400

A                            1%                                         5%

S                             57%                                       65%

L                             57%,                                     30%

Hct                         32%                                       29%

Hb                          10.4                                       9.4

PLAQ.                   200000                 200000

Ret 0.8%

Glucose: 85

Urea: 64

Creatinine 0.63

Biochemistry (7/14/12):

DHL: 1528

TGO: 555

TGP: 126

FA: 864

Uric Ac: 8.7

Ca 7

P 4.9

Mg 1.5

Total Protein: 4.2

Albumin: 1.9

Globulins: 2.3.

CPK, CK 116,

CK-MB 33.4.

C3 24

C4: 3.6

ASO: 15

FR: 198.3

Hematology: TC 5min TP TS 2 min 14.4 "APTT 46" TT 24.8 "135 Fibrinogen

ESR 58

Serology (7/10/12):

Toxoplasma IgM 2041

Coprocultivo (7/10/12): Campylobacter
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