[CIS PIDD] Warts and T-cell lymphopenia

[Kirkpatrick, Charles]

I considered WHIM when I got the referral.  It is still possible, but seemed less likely in view of the normal immune globulins and random  antibody titers and normal neutrophil value.  I also wondered about WHIM appearing as a new illness in a person aged 48 years.

Thanks,

Charles K.

From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Jane Peake
Sent: Wednesday, August 08, 2012 11:45 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS PIDD] Warts and T-cell lymphopenia

Hi
Has WHIM syndrome (Warts, Hypogammaglobulinaemia, infections and myelokathexis) been considered? I have 2 patients confirmed genetically with this. Marked lymphopenia and also neutropenia has been noted in my patients but only very mild hypogammaglobulinaemia in one and normal in the other. I have had success (after all else failed)  in getting rid of extensive warts in these patients by a kindly surgeon taking them to theatre and using diathermy to each one of the warts. They didn't grow back!
Cheers Jane

Dr Jane Peake
Paediatric Immunologist and Allergist
Senior Lecturer
University of Queensland
level 3 Foundation Building
Royal Children's Hospital
Herston Rd, Herston QLD 4029
Tel (61 7) 33655333 or 36365059
Fax (61 7) 33655455
[cid:image001.jpg at 01CD761F.44CB2480]

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 Kirkpatrick, Charles
Sent: Wednesday, 8 August 2012 12:35 AM
To: '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
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