[CIS PIDD] [cis-pidd] Patient question with low T & B cells

[Kirkpatrick, Charles]

I agree with Dr. Paris.  Look for a thymoma.

It would be interesting to check the output of new T-cell from the thymus

Chuck Kirkpatrick

From: Pere Soler Palacin [mailto:psoler at vhebron.net]
Sent: Friday, April 04, 2014 11:56 AM
To: CIS-PIDD
Subject: Re: [cis-pidd] Patient question with low T & B cells

hiv NEG?
Pere Soler Palacín, MD, PhD.
Pediatric Infectious Diseases and Immunodeficiencies Unit. Hospital Universitari Vall d'Hebron.
Assistant Professor. Universitat Autònoma de Barcelona.
Passeig de la Vall d'Hebron 119-129.
08035 Barcelona. Spain.
Tel: 0034934893140. Fax: 0034934893039.
E-mail: psoler at vhebron.net<mailto:psoler at vhebron.net>; 34660psp at comb.cat<mailto:34660psp at comb.cat>. Web: www.upiip.com<http://www.upiip.com/>.



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----- Mensaje original -----
De: "Kenneth Paris" <kparis at lsuhsc.edu>
Para: "CIS-PIDD" <cis-pidd at lists.clinimmsoc.org>
Enviados: Viernes, 4 de Abril 2014 19:45:19
Asunto: Re: [cis-pidd] Patient question with low T & B cells
In that age group and with those symptoms, I would definitely consider a thymoma.  She needs a chest CT.

Ken Paris MD
LSU Health Sciences Center
New Orleans, LA

Sent from my Verizon Wireless 4G LTE DROID


"Wiens, Lynn A MD" <lawiens at saintfrancis.com> wrote:

I have a 52 y/o white female who came to the office with oral thrush and persistent coughing. Her PFTs are unremarkable and her oral thrush resolved with Diflucan.  As part of her evaluation, I obtained a lymphocyte panel which reveals the following (I did repeat the test to confirm)

1.       CD4+/CD3+  46 (nl 410-1590)

2.      CD8+/CD3+ 1678 (nl 190-1120)

3.      CD4+/CD8+ 0.03 (0.90-3.5)

4.      CD19 B lymphs 20 (200-1300)

She has surprisingly good antibody levels given her low CD19 cts.  My question is:

1.      Other than oral thrush, she doesn’t have serious infections yet.  Is there any additional evaluation you would recommend?

2.      Any other treatment at this time in addition to supportive care?  I am quite concerned with that low CD4+ and CD 19 counts…how do I prevent the “time bomb?”

Thanks to all!

Lynn A. Wiens, MD

Warren Clinic

6160 South Yale Avenue  Tulsa, OK 74136

Specializing in the care of Allergy, Asthma, Sinus disease, and Chronic Infections

http://tulsaallergynews.com

Office: 918-495-2636

Cell: 918-550-1200

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