[CIS PIDD] Warts and T-cell lymphopenia

[Kumar, Ashish]

Stan,
This is unlikely an immune deficiency. Laryngeal papillomas are known to recur after resection. Intralesional Cidofovir, HPV-vaccination are some of the adjuvant therapies that are described as successful in some patients. I have seen one patient respond to Gefitinib (EGFR inhibitor).

Ashish

From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Stan Ress
Sent: Wednesday, August 08, 2012 2:49 PM
To: <pagid at list.clinimmsoc.org>
Subject: Re: [CIS PIDD] Warts and T-cell lymphopenia

I've just seen a 18-year old girl who was referred for evaluation of possible underlying immune deficiency. She was found to have a large papillima below her vocal cords causing hoarseness, that was repeatedly ressected by ENT surgeon over several months, and also injected with Zidovudine several times but with no response. On flow she had reduced NK cell numbers , absolute values 69 cells/ul & 80 cells/ul on 2 occasions. Normal B-cells & T-cells & CD4/8 ratio. Functional NK activity has not been done.

I was very interested to read about Terry Harville's approach of nebulized alpha-IFN for vocal cord warts, & wonder if he would be willing to share details of the protocol.

Thanks & Regards,

Stan Ress




--
Stanley Ress
Associate Professor of Medicine
Head: Division of Clinical Immunology
Department of Medicine
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>>> "Harville, Terry O" <HarvilleTerryO at uams.edu<mailto:HarvilleTerryO at uams.edu>> 2012/08/07 11:27 PM >>>

Chuck,

We have been able to get rid of warts in immunodeficient patients by local injections of alpha-interferon.  We has used alpha-interferon topically with success for optical varicella, and nebulize for vocal cord warts.
Terry Harville MD PhD
-Medical Director, Special Immunology Laboratory
-Medical Director, Histocompatibility Laboratory
-Medical Director, Immunogenetics and Transplantation Laboratory
-Specialist in Pediatric Immunology and Rheumatology
Departments of Pathology and Laboratory Services and Pediatrics
University of Arkansas for Medical Sciences
4301 West Markham
Mail Slot #502
Little Rock, AR  72205-7199

Work Phone 1..........................................................501.686.7257
Work Phone 2..........................................................501.526.7511
Work Phone 3..........................................................501.686.7556
Work Phone 4..........................................................501.364.1885
Work Fax 1..............................................................501.686.7443
Work Fax 2..............................................................501.526.4621

Email.....................................................harvilleterryo at uams.edu

Special Immunology Laboratory..............................501.364.1804
Histocompatibility Laboratory..................................501.686.7257
Immunogenetics and Transplantation Laboratory...501.686.7374

On Aug 7, 2012, at 9:36 AM, "Kirkpatrick, Charles" <Charles.Kirkpatrick at ucdenver.edu<mailto:Charles.Kirkpatrick at ucdenver.edu>> wrote:
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

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