[CIS PIDD] [cis-pidd] Recurrent pharyngeal thrush

[Prescott Atkinson, M.D.]

I have had a couple of patients with recurrent oral candidiasis and very low MBL levels - always a question as to whether there could be something else as well, I suppose.  One was a patient who developed candidiasis of the vocal cords after starting on CPAP.



T. Prescott Atkinson, MD PhD, Professor and Director

Division of Pediatric Allergy, Asthma & Immunology

University of Alabama at Birmingham

Tel: 205-939-9072

Fax: 205-975-7080

________________________________
From: Paris, Kenneth [kparis at lsuhsc.edu]
Sent: Tuesday, March 18, 2014 2:18 PM
To: CIS-PIDD
Subject: Re: [cis-pidd] Recurrent pharyngeal thrush

I would consider thymoma.  I have made the diagnosis once before in a patient with an identical history and age.  Resection was curative, and candidiasis did not recur.  She had no hypogammaglobulinemia.  She did eventually develop mild MG as well.

Best regards,

Ken

Ken Paris MD
LSU New Orleans
Children's Hospital New Orleans
JM Center for PI

Sent from my Verizon Wireless 4G LTE DROID


Santhosh Kumar/FS/VCU <skumar at vcu.edu> wrote:

Hello,
I would appreciate any input in regards to this patient I have been following.

59 y/o WF with hx of mild intermittent asthma, VCD, evaluated initially for recurrent hoarse voice which responds partially to oral steroids. She was eventually sent to ENT who noted thrush in pharynx and larynx and no other significant abnormality during one of her episodes. She has had immune work up including normal CBC w/diff, LEP, vaccine titers, immunoglobulin levels (IgM has consistently been above normal 334mg/dl), normal lymphocyte stimulation test, normal response to Candida intradermal testing, decreased response to Candida antigen stimulation. She responds well to diflucan and her hoarse voice resolves in 2-3days after starting diflucan. She is currently on Diflucan prophylaxis (100mg daily) with no more episodes for the last 3 months. She has no history of significant infections or invasive fungal infection, although she does give a history of frequency vaginal Candida infection. No nail changes or any other signs of fungal infection else where. We also got her Th17 quantitative and function which were normal. I am currently thinking of MPO deficiency but unable to find a lab which would perform this test. Any other suggestions in the work up of this patient would be greatly appreciated.

Thank you,

Santhosh Kumar, MD
Assistant Professor,
Allergy & Immunology
Medical College of Virginia
Ph-  804-628-1605
Fax-804-828-1751

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