[CIS PIDD] [cis-pidd] Mild neutropenia, recurrent skin infections, allergy, lymphadenopathy

[Eleonora Gambineri]

Dear all,

I would like your inputs on a tricky case. Please see below.

11 y/o boy  (born in 2002)

At birth he was diagnosed with patent foramen ovale and patent ductus arteriosus, not hemodynamically significant. Spontaneous closure at 20 months of age (last checked 6 years old).

Allergy: Allergic to peanuts (had 2 episodes of anaphylactic shock in 2005), milk and egg (oral allergy syndrome and abdominal pain is reported), inhalants (Dermatophagoides, Alternaria, etc). He follows a diet without milk and dairy products, eggs and nuts. 

GI tract: in the early years of life he was diagnosed with gastroesophageal reflux. However the  PH-metry resulted normal. From about 2 years complains recurrent abdominal pain on a daily basis, which occur several times during the day, mainly after meals, already present upon awakening, and that can not be solved with the evacuation. Evaluated several times by the physician who has encountered gas. Alvo reported regular daily, sometimes with incomplete emptying.

Infections: at 2y/o, for the presence of chronic lateral cervical lymphadenopathy and the frequent finding of low levels of neutrophils, (ca 1500-2000/mm3). Cyclic neutropenia was ruled out. Neutrophil function test was normal. Infectious mononucleosis at 3 years of life. He has been suffering from  numerous episodes of periungual infection and skin abscesses when gets minor injuries. Two recent episodes of pneumonia with bronchospasm (8y/o) and asthma-related episodes of bronchitis. He had a tooth abscess on residual deciduous tooth (reported a delay in dental exchange) and numerous cavities.

Recent immunology w/up:

Neutrophils low-ish (1737/μL)

Igs normal (IgG2 at lower levels), total IgE 382 kU/L ,  Ab anti tet present

Lympho subsets normal/proliferation normal

NBT test normal

ANA negative

tTG and AGA negative

STAT3 sequence: wild type



Recently he underwent surgery to remove a suspected submental cyst that turned out to be an inflamed lymph node (histology report not available).

I would feel to explore a bit more on the innate immunity side. 
Any suggestions?

Your inputs are highly appreciated.

Best wishes,
Ele

*******************************************************************
Eleonora Gambineri, MD
Researcher/Assistant Professor

Department of "NEUROFARBA": Section of Child's Health
University of Florence 

Department of Haematology-Oncology: BMT Unit
Department of Fetal and Neonatal Medicine: Rare Diseases,
"Anna Meyer" Children's Hospital

Viale Gaetano Pieraccini,24
50139 FIRENZE
ITALY
Tel +39 055 5662405 (office)/055 5662606(BMT ward)
Fax +39 055 4221012
e-mail: eleonora.gambineri at unifi.it; e.gambineri at meyer.it
********************************************************************






---
The CIS-PIDD listserv is supported by the Clinical Immunology Society
The science & practice of human immunology

P: +1.414.224.8095
E: info at clinimmsoc.org

Not a member of CIS? Please visit www.clinimmsoc.org to join!

You are currently subscribed to cis-pidd as: pagid at list.clinimmsoc.org.
To unsubscribe click here: http://lm.clinimmsoc.org/u?id=183939985.3ea13d40a15475ac00ebbd9cd8a37d6d&n=T&l=cis-pidd&o=43535386
or send a blank email to leave-43535386-183939985.3ea13d40a15475ac00ebbd9cd8a37d6d at lists.clinimmsoc.org
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://seven.pairlist.net/pipermail/pagid/attachments/20130627/f3fbb85f/attachment-0001.html>