[CIS PIDD] [MARKETING][cis-pidd] T cell lymphopenia/cryptococcal meningitis

[CIS-PIDD]

Hi Larry, 

In USA, NIH does this, contact Steve Holland. 
I do believe they still have the panel even after Sarah Browne moved to FDA? If needed, contact Joie Davis (NIH nurse), who has in the past handled these anti-cytokineAb tests.  

In Europe, Rainer Doffinger/ Cambridge measures a broad panel and Leif Hanitsch/ Charite measures at least some of them. 

This sounds like a case which NIH and/or Cambridge might do free of charge as part of an ongoing investigation.

Quite a case you have there, happy hunting!! 

BTW I would also suggest the same dg, though I would also probably do yet a neck MRI to rule out a thymoma that is somewhat unconventionally cranial. And in the end, a thymoma would have the same mechanism, at least partially. And sometimes the thymoma is visible only after 6-12 mo of follow up, so you may want to re-check. Personally however, I have experience only from 5 thymoma patients. 

Mikko



oyl Mikko Seppänen
Harvinaissairauksien yksikkö (HAKE), HUS
 
Mikko Seppänen, MD, PhD, Associate professor 
Specialist in Internal Medicine and Infectious Diseases
Chief, Rare Disease Center, Helsinki University Hospital (HUH)
Children’s Hospital, P.O.Box 280
FI-00029 HUS
FINLAND
&
Senior Consultant (PIDD)
Adult Immunodeficiency Unit
Inflammation Center, HUH

phone +358 9 47180201
GSM +358 50 4279606
fax +358 9 47174703




-----Alkuperäinen viesti-----
Lähettäjä: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org] 
Lähetetty: 6. lokakuuta 2015 4:28
Vastaanottaja: CIS-PIDD
Kopio: lb4m at virginia.edu
Aihe: [MARKETING][cis-pidd] T cell lymphopenia/cryptococcal meningitis

Posting on behalf of Larry Borish <lb4m at virginia.edu>:

52 previously completely healthy M.  Presents to hospital with cryptococcus meningitis.  CD4’s are 0.  No big surprise there.  But CD8s are also 0.  CD3s are 0.  CD19/CD20 and IG’s all normal.  NKs slightly low.  Chest CT is not remarkable.  No thymoma and no lymphadenopathy.  His bone marrow normal, except for absence of CD3, CD4, and CD8 cells.  But nothing to suggest lymphoma.  

I suspect autoimmune but can’t get my laboratory to do indirect IF.  Does anyone have any other ideas or know of a lab who can screen for autoantibodies?

Larry Borish, M.D.
Professor of Medicine
Asthma and Allergic Disease Center
University of Virginia
Charlottesville, VA 22908
(434) 243-6570
lb4m at virginia.edu

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