[CIS PIDD] [cis-pidd] Severe aphthous ulcers in an adolescent with CVID

Thu Jun 5 12:10:58 EDT 2014

Rich:  Never heard of Debacterol before now.  Do you have them come in and apply it?  Write a script for it?

Kathy

Kathleen A. Haines, MD
Section Chief, Pediatric Immunology
Section of Pediatric Rheumatology & Immunology
Hackensack UMC
30 Prospect Ave.
Hackensack, NJ 07601

Tel: 551-996-5306
Fax: 201-996-9815
khaines at HackensackUMC.org (Please note domain change)

[EmailSignature]

From: Richard Wasserman [mailto:drrichwasserman at gmail.com]
Sent: Thursday, June 05, 2014 10:08 AM
To: CIS-PIDD
Subject: Re: [cis-pidd] Severe aphthous ulcers in an adolescent with CVID

You might try Debacterol<http://www.debacterol.com/prof_ci.html>. I agree with Ken, the lesion should be biopsied.
Richard Wasserman

On Thu, Jun 5, 2014 at 6:57 AM, Leiding, Jennifer <jleiding at health.usf.edu<mailto:jleiding at health.usf.edu>> wrote:

We have a similar patient with Hyper IgM syndrome and neutropenia, responding well to Neupogen but continues with persistent severe apthous stomatitis. Any suggestions?

Thanks,

Jennifer Leiding

________________________________
From: Elie Haddad [elie.haddad at umontreal.ca<mailto:elie.haddad at umontreal.ca>]
Sent: Thursday, June 05, 2014 9:08 AM
To: CIS-PIDD
Subject: Re: [cis-pidd] Severe aphthous ulcers in an adolescent with CVID
Interesting.
Jane, did you try Colchicine ?
Elie

Elie Haddad, MD, PhD,
Professor of Pediatrics, University of Montreal,
Head, Pediatric Immunology and Rheumatology Division,
CHU Sainte-Justine, 3175 Cote Sainte-Catherine
Montreal, QC, H3T 1C5, Canada
Ph: 1 514 345 4713<tel:1%20514%20345%204713>
fax: 1 514 345 4897<tel:1%20514%20345%204897>
e-mail: elie.haddad at umontreal.ca<mailto:elie.haddad at umontreal.ca>

Le 2014-06-05 à 09:01, Monica Lawrence a écrit :

Hi Jane,

We recently submitted a case report of using high dose (1-2 g/kg/month) IVIG successfully for the treatment of refractory recurrent aphthous stomatitis in a previously steroid-dependent 3 year old boy (without CVID/other immunodeficiency).   He had difficulty tolerating the high dose IVIG so we switched to SCIG (250 mg/kg/week) and he has been successfully maintained on this therapy for >1 year now without need for any other therapy.   So, you may try increasing the dose/frequency of your IVIG and see if the ulcers also improve.

Best,

Monica G. Lawrence, MD
Assistant Professor of Medicine
Department of Medicine
Division of Asthma,Allergy & Immunology
University of Virginia
PO Box 801355
Charlottesville, VA 22908
434-243-6811<tel:434-243-6811>
ml4nz at virginia.edu<mailto:ml4nz at virginia.edu>

On Jun 5, 2014, at 2:21 AM, Jane Peake <j.peake at uq.edu.au<mailto:j.peake at uq.edu.au>> wrote:

Hi all
I have a young girl with CVID who has been plagued with severe disabling aphthous ulcers for many years. Since starting on IVIg her infectious problems have largely resolved and her ulcers are better but they are still problematic. She gets them on her tongue, buccal mucosa and roof of the mouth and when she has them she finds eating and speech very difficult. Episodes are intermittent but she rarely goes more than a couple of weeks without a severe episode. She has had a couple of episodes of labial lesions but since starting doxycycline (on the advice of the gynaecologists) she has only had one episode when they had run out of the doxycycline. We have tried a variety of topical treatments – local anaesthetics and steroids. She responds well to oral steroids but these cannot be used regularly. Does anybody have any other ideas in this setting?
Thanks for any suggestions
Cheers Jane

Dr Jane Peake
Paediatric Immunologist and Allergist
Senior Lecturer
University of Queensland
level 3 Foundation Building
Royal Children's Hospital
Herston Rd, Herston QLD 4029

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