[CIS PIDD] [cis-pidd] question about dysuria in a CVID patient_a follow-up
Dewton Vasconcelos
dmvascon at usp.br
Mon Jul 15 08:05:00 EDT 2013
Congratulations! Well done!
Thank you for the update about the patient.
Dewton
Dewton de Moraes Vasconcelos, MD, PhD
Primary Immunodeficiencies Outpatient Unit ADEE3003
Lab. of Medical Investigation Unit 56
University of São Paulo School of Medicine
YaeJean Kim wrote:
> 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
> <mailto: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><mailto: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><mailto: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><mailto: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><mailto: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><mailto: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 <mailto:yaejeankim at skku.edu>
>
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