[CIS PIDD] [cis-pidd] a question about 6 week old boy with low B cells and heart anomaly

[YaeJean Kim]

Dear Joe,

Thank you for your suggestion.
Yes, the baby's condition has been stabel and is going to go home soon. I
saw the baby yesterday and we planned to see in a month with lab f/u.
Sure avoiding rotavirus vaccine would be a good idea at this point. Thanks
a lot.

YaeJean

On Wed, Nov 28, 2012 at 3:41 AM, Church, Joseph <JChurch at chla.usc.edu>wrote:


>  Yae-Jean:****

>

> ** **

>

> **·         **I think the *S. aureus *is secondary to the trach,

> neutrophil dysfunction of newborns and NICU environment.  ****

>

> **·         **The IgG level of 274 is within normal range for our lab

> (198-577), and should not predispose to Staph.****

>

> **·         **The eosinophilia may be a non-specific finding in sick

> neonates (Lawrence R et al Ann Allergy 1980 44;349-52).****

>

> ** **

>

> I would follow, repeat B-cells and Ig's in a month.  ****

>

> ** **

>

> I would avoid live virus vaccines, e.g. rotavirus for now.****

>

> ** **

>

> Joe Church, MD****

>

> Children's Hospital Los Angeles****

>

> ** **

>

> ** **

>

> ** **

>

> *From:* YaeJean Kim [mailto:yaejeankim at skku.edu]

> *Sent:* Monday, November 26, 2012 8:58 PM

> *To:* CIS-PIDD

> *Subject:* [cis-pidd] a question about 6 week old boy with low B cells

> and heart anomaly****

>

> ** **

>

> Dear all,****

>

>  ****

>

> I have a question about 6 weeks old boy with very complicated heart

> disease and slightly low B cells and mild eosniophilia. ****

>

>  ****

>

> This is a boy born at full-term with complicated heart disease and

> tachycardia (PSVT/ atrial flutter).****

>

> The baby is in PICU on ventilator due to tachycardia and his tracheal

> aspirate grew *S. aureus*. It was not sure whether he had bacterial

> pneumonia although he had initially increased WBC count at 14.725x10^3/uL.

> ****

>

>  ****

>

> His CBC now is WBC 8.0 x10^3/uL, Hb 11.9g/dL, PLT 356K/uL with diff count

> of S48, E12, L30, M8. (absolute eos counts 960/uL)****

>

> Initially, positive culture due to S. aureus from the tracheal aspirate

> and mild eosinophilia at this age caught my eyes and I suspected hyper IgE

> syndrome. (there is no family hx of PID, though). ****

>

> So, we did the work-up and now the labs are as below..I see now he has

> somewhat low B cells and low level of IgG, A, M (this could be within

> normal range but lower end..).****

>

>  ****

>

> IgG 274 mg/dL  (251-906)****

>

> IgA 5 mg/dL  (1.3-53)****

>

> IgM 9 mg/dL  (17-105) ****

>

> IgE 8.8 IU/mL****

>

> C3, C4, CH50 normal****

>

>  ****

>

> Lympho subset****

>

> CD3       2088/uL (87%),  ****

>

> CD4      1656/uL (69%),  ****

>

> CD8       384/uL (16%)****

>

> CD19      192/uL (*8%*)****

>

> CD16+56+CD3-  72/uL (3%)****

>

>  ****

>

> Pt with XLA usually present older than this age..and B cell is not that

> low (it is above 1-2%)...The reason for eosinophilia is not known yet..***

> *

>

> Do you think it is enough to suspect any forms of PID (such as hyepr IgE

> or any form of hypogammaglobulinemia) at this stage? ****

>

> I appreciate any feedback from you.****

>

>  ****

>

> Thank you.

> ****

>

> -- ****

>

> Yae-Jean Kim, MD, PhD ****

>

> Associate Professor ****

>

> Division of Infectious Diseases ****

>

> Department of Pediatrics ****

>

> Sungkyunkwan University School of Medicine ****

>

> Samsung Medical Center ****

>

> 50 Irwon-dong Gangnam-gu ****

>

> Seoul, Korea

> Tel)  +82-2-3410-3539, 0987  Fax) +82-2-3410-0043****

>

> yaejeankim at skku.edu****

>

> ** **

>

> ---****

>

> The CIS-PIDD listserv is supported by:****

>

> [image: Description: Image removed by sender.]

>

> *The science & practice of human immunology*

>

> P: +1.414.224.8095

> E: info at clinimmsoc.org

>

> Not a member of CIS? Please visit www.clinimmsoc.org<https://cis.execinc.com/edibo/Signup>to join!

> ****

>

> You are currently subscribed to cis-pidd as: jchurch at chla.usc.edu.

> To unsubscribe click here:

> http://lm.clinimmsoc.org/u?id=183824426.292477f2b5b77a2887c3a0060aad53a7&n=T&l=cis-pidd&o=42249910

> ****

>

>

> ---------------------------------------------------------------------

> CONFIDENTIALITY NOTICE: This e-mail message, including any attachments,

> is for the sole use of the intended recipient(s) and may contain

> confidential

> or legally privileged information. Any unauthorized review, use, disclosure

> or distribution is prohibited. If you are not the intended recipient,

> please

> contact the sender by reply e-mail and destroy all copies of this original

> message.

>

> ---------------------------------------------------------------------

>

> ---

>

> The CIS-PIDD listserv is supported by:

>

>

> *The science & practice of human immunology*

>

> P: +1.414.224.8095

> E: info at clinimmsoc.org

>

> Not a member of CIS? Please visit www.clinimmsoc.org<https://cis.execinc.com/edibo/Signup>to join!

>

> You are currently subscribed to cis-pidd as: yaejeankim at skku.edu.

> To unsubscribe click here:

> http://lm.clinimmsoc.org/u?id=183824538.9b340b1c99503b8ad95618ad676dbd75&n=T&l=cis-pidd&o=42253139

>

>



-- 
Yae-Jean Kim, MD, PhD
Associate Professor
Division of Infectious Diseases
Department of Pediatrics
Sungkyunkwan University School of Medicine
Samsung Medical Center
50 Irwon-dong Gangnam-gu
Seoul, Korea
Tel)  +82-2-3410-3539, 0987  Fax) +82-2-3410-0043
yaejeankim at skku.edu

---
The CIS-PIDD listserv is supported by the Clinical Immunology Society
The science & practice of human immunology

P: +1.414.224.8095
E: info at clinimmsoc.org

Not a member of CIS? Please visit www.clinimmsoc.org to join!

You are currently subscribed to cis-pidd as: pagid at list.clinimmsoc.org.
To unsubscribe click here: http://lm.clinimmsoc.org/u?id=183939985.3ea13d40a15475ac00ebbd9cd8a37d6d&n=T&l=cis-pidd&o=42255499
or send a blank email to leave-42255499-183939985.3ea13d40a15475ac00ebbd9cd8a37d6d at lists.clinimmsoc.org
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://seven.pairlist.net/pipermail/pagid/attachments/20121128/7af51286/attachment.htm>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: image/jpeg
Size: 620 bytes
Desc: not available
Url : <http://seven.pairlist.net/pipermail/pagid/attachments/20121128/7af51286/attachment-0001.jpe>