[CIS PIDD] [cis-pidd] question about dysuria in a CVID patient_a follow-up

[YaeJean Kim]

Dear All,

Thank you so much for your responses to my previous question.
This is a quick follow-up note.
BK virus, AFB, adenoviruses were all negative.

However, it was POSITIVE for ureaplasma!
I put her on doxycycline and she already started to feel so much better
after a couple of days of medication.
The patient and her family were so happy with the symptom improvement and
she did well on her final exams!!
I am also re-evaluating her immune status as suggested.

Thank you again and have a great weekend!

Regards,

YaeJean



On Tue, Jun 11, 2013 at 8:36 AM, Routes, John <jroutes at mcw.edu> wrote:


>

> agree with Dewton

>

>

>

> John M. Routes, MD

> Chief, Section of Allergy and Clinical Immunology

> Professor of Pediatrics, Medicine, Microbiology and Molecular Genetics

> Department of Pediatrics

> Children's Hospital of Wisconsin

> Medical College of Wisconsin

> 9000 W. Wisconsin Ave.

> Milwaukee, WI  53226-4874

> Phone: Office 414-266-2640

> Fax: 414-456-6487 (Clinical)

> Fax: 414-456-6323 (Laboratory)

> Email: jroutes at mcw.edu<mailto:jroutes at mcw.edu>

>

>

>

>

>

> On Jun 10, 2013, at 10:32 AM, <dmvascon at usp.br<mailto:dmvascon at usp.br>>

>  wrote:

>

> 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

>

>

> ________________________________

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

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

> 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-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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-- 
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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