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

[dmvascon at usp.br]

Hi Yae-Jean 

She seems too sick for a CVID patient. 
Did you check for a possible STAT5b mutation? Maybe ADA deficiency? 
Does she have autoantibodies? Does she present any bladder malformation? granulomas? 
What about the possibility of a mycobacteriosis? 

Best, 

Dewton 

Dewton de Moraes Vasconcelos, MD; PhD 
University of São Paulo School of Medicine 

----- Mensagem original -----


> De: "YaeJean Kim" <yaejeankim at skku.edu>

> Para: "CIS-PIDD" <cis-pidd at lists.clinimmsoc.org>

> Enviadas: Segunda-feira, 10 de Junho de 2013 11:52:26

> Assunto: [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-Je an 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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