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

[Boyce, Thomas G., M.D.]

check for ureaplasma

From: bounce-43464345-183824398 at lists.clinimmsoc.org [mailto:bounce-43464345-183824398 at lists.clinimmsoc.org] On Behalf Of YaeJean Kim
Sent: Monday, June 10, 2013 9:52 AM
To: CIS-PIDD
Subject: [cis-pidd] question about dysuria in a CVID patient

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<mailto:yaejeankim at skku.edu>

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