[CIS PIDD] [cis-pidd] 12 yo with oral candidiasis

[Kirkpatrick, Charles]

Richard:

I would do a DTH test for Candida.

Does the patient's serum suppress proliferative responses to candida by normal (candida +) T-cells?  I find this with some young women with recurrent vaginal candidiasis.  After 2-3 months of fluconazole the suppressive activity is lost, and then, the infections do not return  unless they are re-exposed.

Chuck

From: Richard Wasserman [mailto:drrichwasserman at gmail.com]
Sent: Tuesday, July 23, 2013 5:58 AM
To: CIS-PIDD
Subject: [cis-pidd] 12 yo with oral candidiasis

I am seeing a 12 yo who presented with oral candidiasis for the first time two months ago. He was treated with nystatin and cleared. One month later the candida returned.

He had been well with no significant infection history, no exposure to oral or inhaled corticosteroids and one course of antibiotics a few months before presentation. There is no significant past medical or family history. When I saw him, the physical examination was normal.

CBC, IgA, IgG, IgM, CD3, 4,8, 19 and 16/56 were all normal, ANA was negative.

The proliferative response to PHA, ConA and PWM and to tetanus were all vigorous. The response to candida was <50% of the lower limit of normal.

What is the best next step?

Thank you,
Richard Wasserman
Dallas

--
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211

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