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

[Hauck, Fabian Dr.med.]

Sounds good to me. Ciprofloxacine might help as well in case of BK cystitis.
________________________________________
Von: Domm, Jennifer [jennifer.domm at Vanderbilt.Edu]
Gesendet: Montag, 10. Juni 2013 17:19
An: CIS-PIDD
Betreff: RE: [cis-pidd] question about dysuria in a CVID patient

Agree. Check for BK and adenovirus in urine by PCR. Also I have found keeping serum magnesium on the higher side helps with smooth muscle relaxation and therefore less spasms. Can also try ditropan or pyridium for symptom relief.

Jennifer Ann Domm, MD
Assistant Professor
Pediatric Hematology-Oncology
Vanderbilt Children's Hospital
Nashville, TN 37232-6310
615-936-1762 (phone)
615-936-1767 (fax)

This e-mail is confidential and privileged pursuant to provisions of Section 63-6-219 of Tennessee Code Annotated, the contractual obligations of Vanderbilt University to its insurance companies, the attorney-client privilege and other applicable provisions of law.

-----Original Message-----
From: Hauck, Fabian Dr.med. [mailto:Fabian.Hauck at med.uni-muenchen.de]
Sent: Monday, June 10, 2013 10:05 AM
To: CIS-PIDD
Subject: AW: [cis-pidd] question about dysuria in a CVID patient

Dear YaeJean,

did you check for BK virus by PCR?

Best wishes, Fabian

Fabian Hauck, MD
Assistant Doctor
Pediatric Hematology and Oncology - Stem cell transplantation Immunological Service Dr. von Haunersches Kinderspital Lindwurmstraße 4
80337 München, Germany
Tel: +49-(0)89-5160-7940
Fax: +49-(0)89-5160-7942
Email: fabian.hauck at med.uni-muenchen.de
________________________________________
Von: YaeJean Kim [yaejeankim at skku.edu]
Gesendet: Montag, 10. Juni 2013 16:52
An: CIS-PIDD
Betreff: [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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