[CIS PIDD] [cis-pidd] Lymphopenia 17 year-old

[Boyce, Thomas G., M.D.]

Hi Jason,



I would check lymphocyte blastogenesis to mitogens.  If okay, I would not prophylax unless CD4 count <200.



Tom



Thomas G. Boyce, MD

Pediatric Infectious Diseases and Immunology

Mayo Clinic

________________________________
From: bounce-43771870-183824398 at lists.clinimmsoc.org [bounce-43771870-183824398 at lists.clinimmsoc.org] on behalf of Jason Raasch [jraasch at midwestimmunology.com]
Sent: Friday, August 30, 2013 4:22 PM
To: CIS-PIDD
Subject: [cis-pidd] Lymphopenia 17 year-old


All,

The following is a brief summary of a patient my colleague now cares for.  [I hope the text formatting is forgiving].

** THE QUESTION: What is your opinion regarding pneumocystis prophylaxis based on his flow cytometry? **

17-year-old male with a history of congenital heart defect and cardiac repair at birth.  Thymus was likely removed with 1st surgery.

Clinically doing very well.  Mild psoriasis. No significant infectious history.  Immunoglobulin levels are normal, CD 19 absolute and percentages  are normal. FISH analysis of DiGeorge was negative for 22q11 deletion at birth and has not been repeated.

He has been noted to have lymphocytopenia with CD3 positive T cells consistently less than 500.  His recent CD3CD4 numbers have fallen due to a decrease in his absolute lymphocyte count and are reported as follows:




July 2013


June 2012


CD3


46%  299/uL


43%   414/uL


CD3CD4


34%  221/uL


30%   289/uL


CD3CD8


19%  124/uL


24%   231/uL


CD4/CD8 ratio


3.00


2.42




CONVERSATIONS ABOUT THIS TOPIC SEEM TO GO AROUND AND AROUND.  JUST LIKE TO HEAR HOW SOME OF YOU MIGHT APPROACH THIS QUESTION.



THANKS.



-J



Jason Raasch, MD

Midwest Immunology Clinic
15700 37th Ave N, Ste 110
Plymouth, MN 55446

TEL: (763) 577-0008
FAX: (763) 577-0192

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