[CIS PIDD] [cis-pidd] Diarrhea after immune stimulation

[Seppänen Mikko]

Agree with Tom,

but also would think more broadly about other AIS diseases, also some novel mutation in NOD2, FMF spring to mind. Sounds quite unique.

Does the mother give some medication/liquids to the child for the fever that could cause the diarrhea?

Have You looked at fecal calprotectin whether the potential gut inflammation is neutrophilic, fecal antitrypsin if gut permeability is affected, CRP if systemic inflammation is demonstrable (best 2-3d after onset)? Next viral URI will possibly enlighten You more...
I would also then check CBC, C components, C1inh, F-eos, dU-methyl histamine, S-Trypt, a.o.t. And probably check for parasites in stool in the meanwhile. Serum electrolytes and stool chloride?

If indeed inflammatory diarrhea, you might also want to go through the excellent tables on monogenic causes of early-onset diarrhea and intestinal inflammation in Gut 2013;62:1795-805 by Uhlig HH?

Mikko Seppänen

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Mikko Seppänen, MD, PhD, Docent (Associate professor/Senior Lecturer)
Specialist in Internal Medicine and Infectious Diseases
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Immunodeficiency Unit
Division of Infectious Diseases
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Lähettäjä: Richard Wasserman [mailto:drrichwasserman at gmail.com]
Lähetetty: 26. helmikuuta 2014 1:15
Vastaanottaja: CIS-PIDD
Aihe: [cis-pidd] Diarrhea after immune stimulation

I have been asked to evaluate a 14 month old girl who has 7-14 days of diarrhea after HIB, Prevnar, DTaP and Rotavirus but not after hepatitis B vaccine. There is also fever to 40C for 6-7 days. She has not had bacterial infections but has had a similar diarrheal response in association with simple viral URI's. It seems as though any immune stimulation triggers diarrhea. I have not seen this before. Any suggestions?
Richard Wasserman

--
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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