[CIS PIDD] [cis-pidd] Adult patient with multiple brain abscesses by Nocardia sp.

[Juan Carlos Aldave Becerra]

Dear Professors,

I hope that you are very well. I would appreciate your invaluable insights regarding the following case.

Today I evaluated a 43-yr-old male patient with the following clinical picture:
- No family history suggestive of PID.
- Previously healthy except for uncontrolled diabetes mellitus diagnosed 1 year ago.
- No history of previous severe or recurrent infections.
- He started 6 months ago with headache. Because of associated limb weakness MRI was performed, which revealed the presence of multiple brain lesions. At first we was treated as neurocysticercosis but he did not improved so a brain biopsy was done. The biopsy revealed an abscess; culture grew Nocardia sp. He is receiving CMX and meropenem.
- Work up has ruled out HIV. No neutropenia. Clinical history does not suggest other causes of secondary immunodeficiency. No dental abscesses. No panasal sinuses infections. No endocarditis.
- Immunologic analysis show a slight decrease of CD4 T cells (total lymphocytes=2208, CD3=645, CD4=308, CD8=286). He has been receiving systemic corticosteroids for brain edema.
- The results of IgG, IgA, IgM, B-cell and NK-cell counts are pending.

I wonder if the patient might have a late-onset PID (CGD? MSMD? CID?) or anti-cytokine antibodies. Currently we do not perform lymphocyte proliferation testing or DHR.

Please, I would appreciate your thoughtful suggestions. 

Thank you very much.
With my best regards,

Juan

Juan Carlos Aldave, MD
Allergy and Clinical Immunology
Lima, Perú

A Dios sea la gloria!
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