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

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

Karin,

Is there a way you can post (or email me) a copy of his chest x-ray?

Tom

boyce.thomas at mayo.edu

-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Karin Chen
Sent: Thursday, September 06, 2012 11:46 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS PIDD] 3 month old Pneumocystis pneumonia, normal labs


Dear Hans and Tom, thanks for your input. The article Tom forwarded was
very helpful and I passed it along to my infectious disease colleagues
for further discussion on the case. 

Karin

________________________________________
From: pagid-bounces at list.clinimmsoc.org
[pagid-bounces at list.clinimmsoc.org] on behalf of Ochs, Hans
[hans.ochs at seattlechildrens.org]
Sent: Wednesday, September 05, 2012 8:40 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS PIDD] 3 month old Pneumocystis pneumonia, normal labs

The rash you describe does not excite me as one typical for Job
syndrome. You are correct, the NIH scoring system suggests that the
typical rash for AD-HIES is eczematous and starts in the newborn period
in most patients - and this is in fact true.
The elevated IgG, M, A may tell us something. What if this was not
really a PCP, but the PJ found by PCR was just "normal colonization" not
disease causing, since PCR picks up a bug or 2. It just happened that
CGD was discovered serendipitously, some 60 years ago, in boys with
hypergammaglobulinemia.
hans

Hans D. Ochs, MD, Dr. med
Professor of Pediatrics | Jeffrey Modell Chair of Pediatric Immunology
Research Center for Immunity and Immunotherapies Seattle Children's
Research Institute | University of Washington

206-987-7450 OFFICE
206-987-7310  FAX
allgau at u.washington.edu, hans.ochs at seattlechildrens.org

OFFICE   1900 Ninth Avenue, Seattle, WA 98101
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Assistant:
Dawn Marie Pares
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dawnmarie.pares at seattlechildrens.org


-----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 10:56 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS PIDD] 3 month old Pneumocystis pneumonia, normal labs


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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