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

[CIS-PIDD]

Juan:

Thank you so much for your update.
Where did you get the anti-GM-CSF antibodies tested?

Joe Church
Children's Hospital Los Angeles

From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org]
Sent: Monday, September 14, 2015 9:33 PM
To: CIS-PIDD
Subject: RE: [cis-pidd] Adult patient with multiple brain abscesses by Nocardia sp.

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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