[CIS PIDD] [cis-pidd] 13mth male with recurrent perirectal abscesses

Tue Jan 5 20:33:22 EST 2016

Hello Benjamin,
Have you ruled out IL-10 deficiency? It would present the same as IL-10R deficiency that has already been excluded. Was the lower endoscopy extended beyond the ileocecal valve to assess terminal ileum and exclude infantile onset Crohn's disease? You mentioned elevated fecal calprotectin that is suggestive of IBD, but lower GI endoscopy could not find any suggestive evidence to support it, and the gastric findings might be nonspecific.Serum IL-10 and LPS-induced IL-10 secretion by peripheral blood mononuclear cells can be measured by ELISA. It might be worhwhile looking into it.Good luck,Soheil
Soheil Chegini, M.D. 

Exton Allergy & AsthmaAssociates 

656 West Lincoln Hwy.

Exton, PA 19341 

Phone: (610) 269-3066 

Fax: (610) 269-8615

      From: CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
 To: CIS-PIDD <cis-pidd at lyris.dundee.net> 
 Sent: Tuesday, January 5, 2016 5:28 PM
 Subject: [cis-pidd] 13mth male with recurrent perirectal abscesses

Hello all,    I have difficult case that I would appreciate your thoughts on.  13mth male with recurrent perirectal abscesses and anal fistulas beginning at 2mths of life.  Other infections include recurrent URI’s, 1 episode of thrush at 2 months, AOM x 10.  No history of pneumonia.  No abscesses elsewhere.  No IBD on endoscopy/colonoscopy.  No known endocrinopathies.    PMHx: Eczema (mild) Food allergy (eggs, milk) Chronic diarrhea    Surgeries:  OR 11 times for surgical management of perirectal abscesses/anal fistulas.    FHx: no PID, no consanguinity, parents are both from Mexico.    Labs/workup:  10/22/2015-bacterial culture from wound positive for fecal flora, fungal culture negative 01/24/2015- bacterial culture from wound positive for mixed enteric flora 02/02/2015-wound culture positive for mixed enteric flora All prior blood cultures negative 01/19/2015 heme occult positive 02/01/2015 CBC: White blood cell count 9.8, hemoglobin 9.5, platelet count 381, absolute neutrophil count 4500, absolute lymphocyte count 4200, absolute eosinophil count 400 09/04/2015 colon fecal calprotectin elevated at 205 09/17/2015: Endoscopy and colonoscopy negative for gross endoscopic findings. Focal chronic inflammation noted in the stomach by pathology. History of elevated inflammatory markers CRP 20.3, ESR 19    09/21/2015: Respiratory burst normal 12/10/15: normal titers to tetanus/diphtheria, IgM normal, IgG elevated at 1141, IgA normal, IgE elevated 599 12/10/15: functional testing for IL-10 receptor normal 12/10/15: Flow (attached): He has mild lymphopenia (ALC 3485) with moderately decreased B cells (592 absolute).  CD4, CD8, NK numbers are all normal.  Normal expression of CD11b and CD18.          We plan to send genetic sequencing as the functional IL-10R testing does not rule out IL-10 deficiency, but I know this is quite rare and wanted to query to listserve to see what else we should consider (CD25 def, IPEX).    Ben     Benjamin L. Wright, MD| Allergy, Asthma & Clinical Immunology Office Tel: 480.301.4284 | Fax: 480.301.9066| Pager 127 or (79)1-5302 | wright.benjamin at mayo.edu Mayo Clinic | 13400 East Shea Boulevard | Scottsdale, AZ 85259     ---  You are currently subscribed to cis-pidd as: schegini at yahoo.com.  To unsubscribe click here: http://cts.dundee.net/u?id=96396879.1c4ba390e5cba8b441ad14c59c207858&n=T&l=cis-pidd&o=3396095  (It may be necessary to cut and paste the above URL if the line is broken)  or send a blank email to leave-3396095-96396879.1c4ba390e5cba8b441ad14c59c207858 at lyris.dundee.net

---
You are currently subscribed to cis-pidd as: pagid at list.clinimmsoc.org.
To unsubscribe click here: http://cts.dundee.net/u?id=96396833.5a9591ccd1e327fe6bc4d1543298c482&n=T&l=cis-pidd&o=3396300
or send a blank email to leave-3396300-96396833.5a9591ccd1e327fe6bc4d1543298c482 at lyris.dundee.net
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <https://pairlist7.pair.net/pipermail/pagid/attachments/20160106/91f76c75/attachment-0001.html>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: image/png
Size: 84860 bytes
Desc: not available
URL: <https://pairlist7.pair.net/pipermail/pagid/attachments/20160106/91f76c75/attachment-0001.png>