[CIS PIDD] [cis-pidd] recalcitrant warts in PLE s/p Fontan

Thu Mar 26 10:16:41 EDT 2015

Any experience with interferon-alpha?

Joe Church
Children's Hospital Los Angeles

From: Heimall, Jennifer [mailto:heimallj at email.chop.edu]
Sent: Thursday, March 26, 2015 6:52 AM
To: CIS-PIDD
Subject: RE: [cis-pidd] recalcitrant warts in PLE s/p Fontan

We have this issue come up pretty commonly in this cohort (about 25% of the Fontan survivors irrespective of PLE). I  work with the CHOP single ventricle survivorship program (SVSP clinic) to follow these kids from the immunology perspective.
Most of the families have had the best response with very frequent re-freezing.  In the folks I have seen, if not responsive to freezing we have used imiquod with assistance from derm with success.
Jennifer Heimall, MD
The Children's Hospital of Philadelphia
Allergy/Immunology
3550 Market Street
3rd Floor
Philadelphia, PA 19104
________________________________
From: Sullivan, Kathleen <sullivak at mail.med.upenn.edu<mailto:sullivak at mail.med.upenn.edu>>
Sent: Thursday, March 26, 2015 6:04 AM
To: CIS-PIDD
Subject: Re: [cis-pidd] recalcitrant warts in PLE s/p Fontan

We see warts in out post-fintan patients with low T cells.  I know Jen Heimall is studying this and she may have some insights or treatment advice.

Kate Sullivan, MD PhD
Wallace Chair
Chief of Allergy Immunology
ARC 1216 CHOP
3615 Civic Center Blvd.
Philadelphia, PA 19104
(p) 215-590-1697
(f) 267-426-0363

On Mar 25, 2015, at 10:17 PM, Perez, Elena Elizabeth <e.perez13 at med.miami.edu<mailto:e.perez13 at med.miami.edu>> wrote:

Dear colleagues,

I met a 16yo male patient last week with PLE s/p Fontan (followed at CHOP), who does not really get sick with recurrent infections but has had a chronic problem with recalcitrant warts all over his hands and fingers (very impressive physical exam).

Traditional therapies have not worked per dermatology. Local dermatologists are looking into using intralesional bleomycin and laser therapy or imiquimod. From what I read the bleomycin treatment can be pretty effective but painful and not without side effects (Dobson 2014 and Pollack 2002).

I'm sure this topic has been covered before, so I apologize if too much "repeat"...

In any case, wondering what the collective experience is in our immunodeficiency patients with intralesional bleomycin and laser vs. imiquimod, how effective, and whether any worrisome side effects have been noted in our populations...? or other alternatives?

[He has a h/o entocort use for PLE during a clinical study and then again later. He has adrenal issues followed by endocrine. Latest WBC, and ALC a 2 years ago was around 420. I don't yet have T cell function or antibody results].

(he is due for follow up at CHOP this summer but if I can help in the meantime, willing to do so)...

Thanks,
Elena Perez
Univ of Miami
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