[CIS PIDD] Warts and T-cell lymphopenia

[Boyce, Thomas G., M.D.]

HPV vaccine, while low risk and thus reasonable, is unlikely to be
helpful. it protects against acquisition of new strains but has no
effect on the patient who is already infected with that strain.
 
Thomas G. Boyce, MD, MPH 
Pediatric Infectious Diseases and Immunology 
Mayo Clinic 
Rochester, MN 55905 
phone: 507-255-8464 
fax: 507-255-7767 


________________________________

From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Jason W.
Caldwell
Sent: Thursday, August 09, 2012 11:01 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS PIDD] Warts and T-cell lymphopenia



I will offer him the HPV vaccine, but was looking into the future if the
vaccine did not provide much protection secondary to his immune
suppression.  (I have not seen him in clinic and don't have any studies
for immune status.  He is follow at Duke for his transplantations)

 

In further review of his record, he did have an OLT liver transplant.
This was secondary to cirrhosis per the notes.  While he was being
evaluated for the liver transplant, he acquired a pneumonia and during
this treatment developed acute renal failure.  Then within a short time
he developed pancreatitis.  With this his CR again began to rise and
then eventually was in renal failure they are calling acute tubular
necrosis.  Ultimately, Duke called him hepto-renal syndrome and he ended
up receiving a liver and cadaveric kidney transplant in 2008.

 

 

 

Jason W Caldwell, DO
Assistant Professor Internal Medicine & Pediatrics
 
Section Pulmonary, Critical Care, Allergic and Immunological Diseases
Medical Center Boulevard  \  Winston-Salem, NC 27157
p 336.716.5166  \  f 336.716.7277  \  pager 336.806.8330
jcaldwel at wakehealth.edu  \  WakeHealth.edu

 

 

 

From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Bleesing, Jacob
Sent: Thursday, August 09, 2012 11:40 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS PIDD] Warts and T-cell lymphopenia

 

Jason:

Just wondering; why not give an HPV vaccine?

Both available vaccines cover type 16, while there may cross-protection
for type 45 (and perhaps new vaccines in the pipe-line).

Out of curiosity (ignorance): where did the donor liver come from (or
asking in another way; CF was not reason to be denied for OLT)?

Jack



________________________________

From: pagid-bounces at list.clinimmsoc.org
[pagid-bounces at list.clinimmsoc.org] on behalf of Jason W. Caldwell
[jcaldwel at wakehealth.edu]
Sent: Thursday, August 09, 2012 9:53 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS PIDD] Warts and T-cell lymphopenia

I have also taken some interest in the discussion about the problematic
warts described in these patients.  

The pediatric ENT called me Monday with a question about HPV.  She is
caring for a patient that has CF.  His CF course has been complicated by
liver failure secondary to medications and has undergone liver
transplant.  He is on chronic immunosuppresion with mycophenolate and
tacrolimus.  ENT is involved because of nasal polyposis that has been
debulked on several occasions. The ENT noticed on the last couple of
procedures that the polyps had a papilloma type of appearance.  She
requested PCR for HPV and the polyps were positive for HPV 16 and 45.

I would also be very interested in the protocol used with alpha
interferon or the one meds used in intralesional injection.

Thanks in advance,

Jason

Jason W Caldwell, DO
Assistant Professor Internal Medicine & Pediatrics

Section Pulmonary, Critical Care, Allergic and Immunological Diseases
Medical Center Boulevard  \  Winston-Salem, NC 27157
p 336.716.5166  \  f 336.716.7277  \  pager 336.806.8330
jcaldwel at wakehealth.edu  \  WakeHealth.edu

 

 

 

From: pagid-bounces at list.clinimmsoc.org [
mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Kumar, Ashish
Sent: Wednesday, August 08, 2012 4:57 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS PIDD] Warts and T-cell lymphopenia

 

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
H47 Old Main Building-room 26
Groote Schuur Hospital and UCT
Observatory 7925
Cape Town
South Africa
TEL:INTERN. + 2721-4066201 or 4066197
FAX:   "    + 2721-4486815
Cell: 0833115482 

email: stan.ress at uct.ac.za


>>> "Harville, Terry O" <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..............................................................501.686.7
443

Work Fax
2..............................................................501.526.4
621

 

Email.....................................................harvilleterryo
@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> 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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