[CIS PIDD] 3 month old Pneumocystis pneumonia, normal labs

[Karin Chen]

Good to know that rash can be minimal in AD HIES. I had always thought there would be at least some obvious eczematous rash presenting in the neonatal period.  The ulcerative lesion on the foot did not require antibiotics and on my exam her skin was totally clear, so I thought there was low likelihood of hyper IgE. I will check IgE and consider STAT3 testing. Karin

________________________________________
From: pagid-bounces at list.clinimmsoc.org [pagid-bounces at list.clinimmsoc.org] on behalf of Freeman, Alexandra (NIH/NIAID) [E] [freemaal at mail.nih.gov]
Sent: Wednesday, September 05, 2012 11:37 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS PIDD] 3 month old Pneumocystis pneumonia, normal labs

Although you described only rash to one foot, STAT3 mutated HIES can present with PCP in this age range and could be a consideration, and rash may be minimal.  I didn't see an IgE listed, but may not be that elevated at this age.
Alexandra

--
Alexandra Freeman MD
Laboratory of Clinical Infectious Diseases
NIAID, NIH
NIH, Bldg 10,Room 12C103
9000 Rockville Pike
Bethesda, MD  20892
Phone 301-594-9045
Fax 301-496-0773
freemaal at mail.nih.gov

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On 9/5/12 1:21 PM, "Karin Chen" <karin.chen at hsc.utah.edu> wrote:



Dear Thomas,

Thank you for your suggestion. I should have highlighted that HIV 1/2 antibodies were negative, HIV1 RNA was negative.  Mother had negative HIV prenatal testing. Both mother and father got retested for HIV after the child's diagnosis, both were negative by mother's report.

Karin
________________________________________
From: pagid-bounces at list.clinimmsoc.org [pagid-bounces at list.clinimmsoc.org] on behalf of Boyce, Thomas G., M.D. [Boyce.Thomas at mayo.edu]
Sent: Wednesday, September 05, 2012 11:13 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS PIDD] 3 month old Pneumocystis pneumonia, normal labs

Karin,

It is not "normal" for 3 month olds to develop PCP, but it can happen.
It is the peak age of incidence in children with perinatal HIV
infection, perhaps because of initial acquisition of the organism at
that time.  However, I would keep looking.  We just saw a very similar
pt, 4 month old boy with confirmed PCP, and normal apparent T cell
numbers and function.  However, in a new polyfunctional T cell assay in
which our lab looks at mitogen stimulated T cell production of IFN, IL2
and TNF, all were markedly reduced compared with controls.

Thomas G. Boyce, MD, MPH
Pediatric Infectious Diseases and Immunology
Mayo Clinic
Rochester, MN 55905
phone: 507-255-8464
fax: 507-255-7767


-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Karin Chen
Sent: Wednesday, September 05, 2012 12:07 PM
To: pagid at list.clinimmsoc.org
Subject: [CIS PIDD] 3 month old Pneumocystis pneumonia, normal labs


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