[CIS PIDD] [cis-pidd] CMV pancreatitis

[Daniel Conway]

Any pathology onnthe mass or the nodes?

Sincerely,
Daniel H. Conway, MD
Assistant Professor of Pediatrics
St. Christopher's Hospital for Children
Drexel University College of Medicine


On Nov 11, 2014, at 5:14 PM, "David Buchbinder" <dbuchbinder at CHOC.ORG> wrote:

> Alright colleagues .... another case.  Not sure if there are particular suggestions for where to move in terms of a diagnostic evaluation. 
>  
> I saw a 7 year old previously healthy male with abdominal pain and pancreatitis. 
>  
> Imaging documented a left lower lobe lung nodule. He also had a large midline retroperitoneal mass, causing encasement of the aorta, celiac axis, SMA, and abutting the IVC. The mass extends to involve the body and head of the pancreas. There is also adenopathy noted in the mesentery and porta hepatis. The mass extends into the retrocrural region and the left adrenal gland. There was marked dilatation of the intrahepatic ducts and the common bile duct. There was splenomegaly with multiple varices. The splenic vein and the portal veins are not well seen, likely due to thrombosis.
>  
> Pathologic examination documented CMV inclusions. His serum CMV PCR levels and his pancreatic drain CMV PCR levels were very elevated. His urine cx also grew CMV. He responded well to bowel rest and about 3 weeks of IV ganciclovir. He was then transitioned to oral valganciclovir. He has now normalized labs, is tolerating food without redevelopment of pancreatitis thus far and his CMV PCR levels are <200. In addition, his abdominal imaging now shows resolution of the mass. His valganciclovir was just discontinued.
>  
> I just started his work-up.  His CBC is unremarkable. His immunoglobulin levels are relatively unremarkable - IgE 229, IgA 132, IgG 1164, IgM 38. NK% 18, NK abs 574, CD19% 9, CD19 abs 292, CD3% 71, CD3 abs 2,160, CD4/CD8 ratio 0.61, CD4 % 23, CD4 abs 691, CD8 % 38, CD8 abs 1,137. Mitogens - PHA 97,398, SI 499, ConA 58,281, SI 375, PWM 17,422, SI 157, Candida 624, SI 4, Tetanus 437, SI 3, Tuberculin 267, SI 2.  HIV testing was negative. 
>  
> -Dave
>  
> David Buchbinder, MD
> Division of Hematology
> CHOC Children's Hospital
> CHOCLX-MGSM made the following annotations
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> Tue Nov 11 2014 13:43:07 
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