[CIS PIDD] Patient with uncontrollable asthma

[Evan Shereck]

 I was wondering if I could have people's opinions on the following patient. She is a 12 year old girl who was diagnosed with asthma at 3 yrs of age when she first started having breathing problems. Since then, her asthma has been very difficult to control. She is on flovent, atrovent, singlulair, zyrtec, prilosec, and albuterol. She needs a pulse of prednisone almost monthly. She cannot do any physical exertion. She has been hospitalized 4 times for her asthma. Last year, she missed over 40 days of school. She has a family history of allergies. Her mom has MS and paternal gm had lupus and scleroderma.

Her pulmonologist cannot find a reason for her having such severe asthma. Her IgE was only slightly elevated at 148. IgG, IgG subclasses, IgM and IgA were all normal. Sweat chloride for CF was normal. She has normal ciliary structure. She had a lymphocyte panel done but it was performed while she was on steroids. It demonstrated:


Decreased total B cells with mildly decreased differentiation to switched memory B cells, Decreased total T cells including decreased CD4 positive and CD8 positive subsets, No monoclonal B cell population identified.


I was wondering If anyone could think of anything else for which I should work-up on this young girl? Other than the severe asthma, she has not had any major infections.


Thanks.

-Evan

Evan Shereck, MD
Assistant Professor of Pediatrics, Co-Director of Pediatric Hematology/Oncology Fellowship
Oregon Health & Science University I  3181 SW Sam Jackson Park Rd, Mail Code: CDRCP  I  Portland, OR 97239
* (Office): 503-494-0829  I  (Fax): 503-494-0714
 * (E-mail): shereck at OHSU.edu

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