[CIS PIDD] Warts and T-cell lymphopenia

[Sorensen, Ricardo]

Charles, over the years we have seen several patients with warts and
profound, persistent  T-cell lymphopenia. Most do pretty well with their
lymphopenia once the warts come under control. One young man developed
the worst, treatment resistant   condilomata you can imagine .
Fortunately, Steve Holland accepted him for evaluation and treatment at
the NIH. No molecular defect was identified but he is now doing well for
several years on interferon treatment. I would give  Steve Holland a
call.

 

If your patient has siblings, you may be surprised that some may have
pretty deep T-lymphopenia  being otherwise healthy. I have also seen
that in one family. The proband got sick  during her pregnancies and
after that went on to live with her lymphopenia and no clinical
problems. Her two healthy brothers had a lymphopenia as severe as hers.
They never had a clinical problem. That may mean that once you get the
warts of your patient under control he may go on to live with his
lymphopenia without further infections.

 

Good luck,

 

Ricardo Sorensen

 

From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Kirkpatrick,
Charles
Sent: Thursday, August 09, 2012 12:08 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS PIDD] Warts and T-cell lymphopenia

 

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

 

 

From: pagid-bounces at list.clinimmsoc.org 
[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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