[CIS PIDD] [cis-pidd] question about dysuria in a CVID patient

[YaeJean Kim]

Dear All,

I have a 14 yo girl with CVID on IVIG replacement therapy every 3 weeks.
She has multiple conditions as below.
- s/p CMV infection diagnosed at outside hospital.
- A huge splenomegaly for which she received splenectomy -> amoxacillin
prophylaxis
- Chronic kidney disease stage 4
- Hypertension
- Short stature, delayed puberty
- interstitial pneumonitis responded to steroid and now off

The reason that I am writing is about *significant dysuria and urinary
frequency*. Multiple urine cultures did not grow anything.
But she complains of severe waxing and waning pain.

This time, she was rolling in the bed because of pain in the suprapubic
area/perineum and fever. At ER, UA showed LE+++, numerous WBC/ HPF but gram
stain and routine urine culture grew nothing. Cefotaxime was started
empirically and the fever is gone, the pain is reduced (I am not sure
whether it was truly due to cefotaxime effect or not)...Anyway, she got
somewhat better but still complains of sudden pain that requires pain meds
on and off.
Image studies showed no definite stones..

Urology and nephrology have seen her but no clear idea. To her, this is a
significant symptom that bothers her daily life.
At this point, I would appreciate any suggestion or advice.

Sincerely,

YaeJean

-------------------------------------------------
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

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