[CIS PIDD] Progressive Fibrosis

[Richard Wasserman]

I was contacted by a 69 y/o physician who presented with gastroenteritis
five years ago but was thought to have cholecystitis. At lap
cholecystectomy he was found to have multiple fibrous adhesions
from ascending colon to abominal wall. There were two subsequent releases
of adhesions with Path diagnosis of fibrous tissue w/o neoplasm or
serositis. Two years later there was an open right colectomy for colonic
inertia with a diagnosis of *fibrosed appendix*.



Post cholecystectomy he developed bilateral forearm lichen planus.



Extensive evaluation was unrevealing except for SS-A >8 and a minor
salivary biopsy that showed grade Grade III siladenitis. MGUS showed a
small 0.24 M-spike & kappa light chains that normalized with prednisone or
methotrexate used to treat fibrosis.



CYP2D6 deficiency.



His major ongoing problems:  Debilitating abdominal pain worsened by
movement. 2 1/2-yr colectomy scar swelling and severe "neuropathic-type"
pains with CT & US evidence of intra-abdominal fibrous adhesions to liver
w/ irregular liver edge suggesting ongoing intraperitoneal fibrosis. He has
been treated with plaquenil, colchicine, methotrexate and prednisone
without benefit. He has experienced improvement after treatment with
doxycycline.



PMH: life-long protracted healing requiring months to resolve simple local
tissue injury such as insect bites and minor cuts. Sites of more
significant tissue injury (operative scars) experience periodic (pain and
inflammation every three to five weeks).



Any thoughts?



He has had extensive evaluations by specialists both in Dallas and at two
major medical centers out of town. If anyone is interested in seeing this
gentleman, he is willing to travel. He asked that I help identify a
physician who would be willing to evaluate him.



Thank you,

Richard Wasserman,

Dallas**

-- 
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211
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