[CIS PIDD] [cis-pidd] Multifocal neonatal Staph

[Conley, Mary Ellen]

I might wait a little while before ordering any more genetic tests if you are comfortable that there will be good follow-up. Clinical course may give you more clues.   Make sure that the patient has a long course of antibiotics.  Even though your oxidative burst is said to be normal, I would not exclude CGD yet.  Laboratory errors do happen, particularly if the lab does not do the test very often.  In the absence of a rash, hyper-IgE is a little less likely and in the US the rare autosomal recessives are less common.
Mary Ellen

Mary Ellen Conley, MD
West Research Tower
LeBonheur Children's Hospital
50 N. Dunlap St.
Memphis TN  38103-2800
Tel     901-287-4657
FAX  901-287-4551
mconley at uthsc.edu<mailto:mconley at uthsc.edu<mailto:mconley at uthsc.edu%3cmailto:mconley at uthsc.edu>>

From: Verbsky, James [mailto:jverbsky at mcw.edu]
Sent: Friday, November 30, 2012 9:15 AM
To: CIS-PIDD
Subject: RE:[cis-pidd] Multifocal neonatal Staph

You could consider IRAK4/Myd88 defects...

Best

James


James W. Verbsky MD/PhD
Associate Professor of Pediatrics and Medical Microbiology and Genetics
Medical College of Wisconsin
Milwaukee, WI  53211
jverbsky at mcw.edu<mailto:jverbsky at mcw.edu>
414-266-6701 (phone)
414-266-6695 (fax)



From: Vickery, Brian Patrick [mailto:bvickery at email.unc.edu]
Sent: Friday, November 30, 2012 8:51 AM
To: CIS-PIDD
Subject: [cis-pidd] Multifocal neonatal Staph

Dear colleagues:

What else besides physiologic immaturity should I be considering in a well-appearing, nontoxic, and non-syndromic 20 day old full-term male infant from a nonconsanguinous Caucasian family who has (presumably hematogenously spread) Staph aureus bone, joint, lung, and brain abscesses - with PMNs in the pus; normal oxidative burst; normal lymphocyte enumeration; and normal IgM & A? There are no vegetations on the TEE. Complements pending.

This kid had a perfectly normal gestation and delivery and was feeding well when he presented to the pediatrician not moving his left arm, appearing clinically very much like an Erb's palsy. The MRI looking for a brachial plexus injury demonstrated a huge effusion with periosteal reaction in that shoulder, which ended up being a Staph abscess.

I welcome your thoughts.

Thanks-
BPV

Brian P. Vickery, MD
Assistant Professor Of Pediatrics
University of North Carolina School of Medicine
Campus Box #7231 | Chapel Hill, NC 27599
919.962.5136 | bvickery at email.unc.edu<mailto:bvickery at email.unc.edu>


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