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

[CIS-PIDD]

Dear professors,
I am happy to give you an update about the follow-up of our patient with multiple brain abscesses by Nocardia sp. Blocking autoantibodies to GM-CSF were detected in patient's plasma.
Thank you for your help.
Best regards,
Juan

Please see my first inquiry below:


___________________________
Dear professors,

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 DHR, 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.

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, Peru 		 	   		  
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