[CIS PIDD] [cis-pidd] Repeated infections in a 55 year old

[Belohradsky, Bernd]

which bacteria were isolated from abscesses/skin/eye infections etc. ?
enteric or oral flora instead of the expected skin or conjunctival flora ?
polymicrobial growth ?

if so, consider possibilty of Munchhausen syndrome (in a nurse) ;
best, Bernd H.Belohradsky
________________________________
Von: jag aggarwal [mailto:jag.aggarwal at gmail.com]
Gesendet: Freitag, 18. Januar 2013 19:47
An: CIS-PIDD
Betreff: [cis-pidd] Repeated infections in a 55 year old

I have a 55 year old nurse who has had recurrent skin infections,  abscess left groin, recurrent eye infections, UTIs,  Often requires IV antibiotics for teh control of infections.

Significant abnormal findings from her immune evaluation are as follows:

1.    Low IgG  at 599 ( n 700 - 1600 )
2.    Low IgG1 at 321 ( n 422 - 1292 )
3.    Low C1q at 8.2 ( n 11.8 - 24.4 )
4.    Positive to HLA class I and II
5.    Hepatitis screen Non reactive to all the antigens
6.    Lymphocyte response to Tetenus   LOW
7.    Lymphocyte resposne to Candida LOW
8.    Abs count CD8+HLA-DR+Lymphocytes  elevated at 242 ( N upto 117 )
9.    CD4 + lyphocytes elevated at 63%  ( n 30 - 58 % )
10.  Low CD38+ IgM- at 1.2 %  ( N 4.1 - 42 % )
11.  Low absolute count of CD+38 IgM- cells at 2.7 ( N 7 - 153 )
12.  Elevated CD27+ IgM+ IgD- % of CD19+ B cells  ( N 0 - 5.3 % )
13.  elevated CD3, CD4 cells

Normal labs include:  CBC, ANA, RA, TSH, T4, ESR, C3, C4, C1INH, CRYOGLOBULINS, CRP,  AH50, IgA, IgM, Neutrophil Oxidative burst,  Tetenus antibody titres, Lymphocyte response to PWM, PHA,  Staph enterotoxin B, Normal switched memory cells,  Normal CD 8, Cd16. Cd19  B  cells

Patient has had a satisfactory response to Pneumovax 23 vaccination with post vaccination titres being in the satisfactory range for 65% of the serotypes.

Any thoughts on this lab clinical and lab profile ?

Thanks

Jag Aggarwal MD
Kansas City MO

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