[CIS PIDD] [cis-pidd] infections, rash, failure to thrive, recurrent hyperosmolar dehydration

[Ravishankar.Sargur at sth.nhs.uk]

Given the history of NKH in the siblings - consider disorders of glycine metabolism and other mitochondrial enzyme defects. 

Ravi 

Ravishankar Sargur
MD,FRCPath,FRCP.
Sheffield 
UK



_____________________________________
From: stephan.ehl at uniklinik-freiburg.de [stephan.ehl at uniklinik-freiburg.de]
Sent: 17 January 2013 15:59
To: CIS-PIDD
Subject: AW: Re: [cis-pidd] infections, rash, failure to thrive, recurrent hyperosmolar dehydration

Consider NEMO,
Stephan Ehl

________________________________

  Von: Elif Dokmeci [edokmeci at gmail.com]
  Gesendet: 17.01.2013 08:47 MST
  An: "CIS-PIDD" <cis-pidd at lists.clinimmsoc.org>
  Betreff: Re: [cis-pidd] infections, rash, failure to thrive, recurrent hyperosmolar dehydration

Hi Eli,

Is this a male infant?
Eosinophilia in blood?
Diarrhea?
I would study FOXp3 gene to rule out IPEX.
Neutropenia?
Throid ab`s, coombs positive anemia?

Elif Dokmeci



On Thu, Jan 17, 2013 at 7:01 AM, Eli Eisenstein <emeisenstein at gmail.com<mailto:emeisenstein at gmail.com>> wrote:
Hello to all,

We are seeking help concerning a 4.5 month old Palestinian Arab
infant, parents first cousins. Two sibs have mild non-ketotic
hypergyceinemia, the patient does not.

Clinical phenotype

Recurrent invasive bacterial infections beginning during the first
weeks of life:
MRSA bacteremia
Peri-anal abscess (Pseudomonas, enterobacter)
Pneumonia, Burkhoderia cepacia cultured from purulent BAL. There is
some question as to whether this organism was a contaminant, as it was
identified in BAL fluid from other patients around the same time.

Diffuse seborrheic derm, steroid responsive, atrichia

Failure to thrive with loose stools. Three acute bouts of
gastroenteritis with fever resulting in severe hyperosmolar
dehydration within hours.

In addition congenital heart disease- huge ASD with L-R shunt and
pulmonary hypertension.


Immune workup thus far:

Thymus radiographically present

IgM- 1310, IgA-126,  IgG-1310

Immunophenotype
CD2             4220
CD3             3720
CD4             2290
CD8-            1430
CD3 CD45RA-           5580
CD3CD45RO-             620
CD19            1364
CD20            1300
CD18                         99%+
HLADR                   1612
CD56+16                 1180

Normal lymphocyte proliferative responses to lectin mitogens,
antigen/IL2 stim not done.

Limited colonoscopy- no IBD
Endoscopy- macroscopic duodenitis, microscopy non-specific



Additional studies graciously performed by our colleagues at other
centers in Israel include the following:

DHR- normal. Normal PMN morphology and chemotaxis.

TREC quantitative – 754 copies/0.5 mcg DNA (normal for lab >400)

CD25, FoxP3 staining comparable to control. Normal glucose. TSH
moderately elevated, autoantibody studies negative. IgE 16, 100 two
months later.

Staining of 24 TCRVb families showed significant skewing. In
particular among CD3CD8+ cells several Vb were not represented, 40% of
cells Vb23+.

Evaluation by FISH and STR negative for materno-fetal engraftment


In short, this child appears to have some form of PID but we do not
feel we have immunologic proof. We are considering WES. Other
suggestions appreciated.

Thanks

Eli Eisenstein
Hadassah
Israel

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--
Elif  Dokmeci, MD
Allergy and Immunology
Assistant Professor of Pediatrics
University of New Mexico Children's Hospital
Phone: 505 272 8185
Fax: 505 272 4549

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