[CIS PIDD] Warts and T-cell lymphopenia

[Milner, Joshua D. (NIH/NIAID) [E]]

Indeed IgE can be normal and phenotypes can be somewhat mild in some cases but has he had these symptoms his whole life? It would be strange to say the least if he were to develop loss of dock8 function at age 34. He seems to have a form of Idiopathic CD4 lymphopenia which can also affect cd8 (clearly recognizing the misnomer). Other lymphocyte subsets are normal?

Josh



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On Aug 7, 2012, at 4:47 PM, "Kumar, Ashish" <Ashish.Kumar at cchmc.org<mailto:Ashish.Kumar at cchmc.org>> wrote:

IgE can be normal in DOCK8 deficiency; GeneDx offers cgh-based testing which will pick up large deletions which are most common. Does this patient have eosinophilia?


From: pagid-bounces at list.clinimmsoc.org<mailto:pagid-bounces at list.clinimmsoc.org> [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Kirkpatrick, Charles
Sent: Tuesday, August 07, 2012 4:42 PM
To: 'pagid at list.clinimmsoc.org<mailto:pagid at list.clinimmsoc.org>'
Subject: Re: [CIS PIDD] Warts and T-cell lymphopenia

Thanks, Tom.  I have been concerned about DOCK8 in this man.  His IgE is normal. Who  does the genetic study?

Chuck

From: pagid-bounces at list.clinimmsoc.org<mailto:pagid-bounces at list.clinimmsoc.org> [mailto:pagid-bounces at list.clinimmsoc.org]<mailto:[mailto:pagid-bounces at list.clinimmsoc.org]> On Behalf Of Fleisher, Thomas (NIH/CC/DLM) [E]
Sent: Tuesday, August 07, 2012 8:40 AM
To: 'pagid at list.clinimmsoc.org<mailto:pagid at list.clinimmsoc.org>'
Subject: Re: [CIS PIDD] Warts and T-cell lymphopenia

? DOCK8
--------------------------
Dr. Thomas Fleisher
Department of Laboratory Medicine
National Institutes of Health
Phone: (301) 496-5668

From: Kirkpatrick, Charles [mailto:Charles.Kirkpatrick at ucdenver.edu]<mailto:[mailto:Charles.Kirkpatrick at ucdenver.edu]>
Sent: Tuesday, August 07, 2012 10:35 AM
To: 'pagid at list.clinimmsoc.org<mailto:pagid at list.clinimmsoc.org>' <pagid at list.clinimmsoc.org<mailto:pagid at list.clinimmsoc.org>>
Subject: [CIS PIDD] Warts and T-cell lymphopenia

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