[CIS PIDD] Warts and T-cell lymphopenia

[Dr. Carsten Speckmann]

  In the context of very low naive Ts and disturbed proliferation it 
sounds very much like a combined immunodeficiency.
Besides DOCK8, you might like to consider STK4 (low naive T cells, low CD4).
Other differentials: in case of low B cells (?) and low monocytes (?) - 
GATA2. In case of normal B cells and low monocytes - IRF8.

Kind regards, Carsten

-- 
Dr. med. Carsten Speckmann
Facharzt
Zentrum fuer Kinderheilkunde und Jugendmedizin
Centrum fuer Chronische Immundefizienz - CCI
Universitaet Freiburg
Mathildenstr. 1
79106 Freiburg
Germany

phone: +49 (0)761-270 43010
mail: carsten.speckmann at uniklinik-freiburg.de
web: www.cci.uniklinik-freiburg.de


Am 07.08.12 16:35, schrieb Kirkpatrick, Charles:

>

> I am evaluating a 48 y/o Caucasian male who developed extensive warts 

> on his hands and feet  about 1998 but spreading widely over feet and 

> hands since 2003.  He was well until then, but he had a cutaneous VZV 

> infection shortly before the onset of warts.  There have been no 

> genital lesions. Failed treatments include liquid nitrogen, Aldara, 

> topical sensitization and application of 2% and 4% CDNB, intralesional 

> injections of Candida skin test antigen, V-Beam laser treatments, duct 

> tape and many herbal and OTC medications.

>

> Labs:  HIV -- negative X2, CBC normal, IgG, IgA, IgM all normal, 

> absolute CD3 -- 260/ul; CD4 190/ul; CD8 -- 60/ul; CD45/CD4 RA 2.3% of 

> total T-cells (control 57.7%); CD45/CD4/RO -96.8% of total T-cells 

> (control 40.8%).

>

> T-cell proliferations to PHA, ConA and PWM all low; proliferation 

> response to tetanus -- low; to Candida normal.  DTH to Candida 28 mm 

> induration.

>

> Any comments about diagnosis?  Does anyone have experience with 

> topical or intravenous Cidifovir in patients such as this?

>

> All comments appreciated.

>

> Charles Kirkpatrick, M.D.

>

> Allergy and Immunology

>

> University of Colorado Health Sciences Center

>



-- 
Dr. med. Carsten Speckmann
Facharzt
Zentrum fuer Kinderheilkunde und Jugendmedizin
Centrum fuer Chronische Immundefizienz - CCI
Universitaet Freiburg
Mathildenstr. 1
79106 Freiburg
Germany

phone: +49 (0)761-270 43010
mail: carsten.speckmann at uniklinik-freiburg.de
web: www.cci.uniklinik-freiburg.de


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