[CIS PIDD] [cis-pidd] Patient for list.

[CIS-PIDD]

This is a 56 y.o. White male with the following: He complains of congestion. He reports no cough, ear pain, eye itching, fatigue, fever, headaches, hoarse voice, rash, rhinorrhea, sinus pressure, sneezing, sore throat or wheezing. (Has infection in his fingertips. ) Allergy triggers do not include dust or pollens. His past medical history is significant for allergies. There are no compliance problems.
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Oral thrush  - Primary   112.0   Allergic rhinitis, unspecified allergic rhinitis type (currently on allergy shots and doing well)   Chronic sinusitis, unspecified location   473.9   Need for desensitization to allergens

Gets recurrent paronychia on fingers; some cellulitis on extremities; multiple episodes of thrush in the past several months.

Exam at last clinic visit was normal-no thrush at that time.

ESR 9 0-17 mm/h Final
HIV-1/2 Ag/Ab Non-reactive Non-reactive Final   HIV Ag/Ab s/co ratio 0.15 <1.00 Final
IgA, Total      287     69-309 mg/dL    Final
        IgM     195     43-271 mg/dL    Final
        IGG     1348    701-1469 mg/dL  Final


DHR (dihydrorhodamine) for CGD; Blood Miscellaneous Lab Test
Result  Value   Ref Range
        Procedure       Neutrophil Oxidative Burst
        Result  89.8 NOI
First measurement Procedure   Neutrophil Oxidative Burst   Result   60.0 NOI   Comment:   Reference Range: > 73
Complement Activity, Total EIA 142 60 - 144 CAE Units Final

Pneumococcal Serotype 1 IgG     0.43    ug/mL   Final

        Pneumococcal Serotype 3 IgG     1.69    ug/mL   Final
        Pneumococcal Serotype 4* IgG    0.34    ug/mL   Final
        Pneumococcal Serotype 5 IgG     6.69    ug/mL   Final
        Pneumococcal Serotype 6B* IgG   0.88    ug/mL   Final
        Pneumococcal Serotype 7F IgG    1.92    ug/mL   Final
        Pneumococcal Serotype 8 IgG     0.95    ug/mL   Final
        Pneumococcal Serotype 9N IgG    1.46    ug/mL   Final
        Pneumococcal Serotype 9V*, IgG  3.40    ug/mL   Final
        Pneumococcal Serotype 12F IgG   1.16    ug/mL   Final
        Pneumococcal Serotype 14* IgG   11.17   ug/mL   Final
        Pneumococcal Serotype 18C* IgG  4.59    ug/mL   Final
        Pneumococcal Serotype 19F* IgG  1.48    ug/mL   Final
        Pneumococcal Serotype 23F* IgG  1.02    ug/mL   Final

CD3 T Lymphs (%)        63      60-87 % Final
        CD3 T Lymphs (Absolute) 1132    690-2540 cumm   Final
        CD4+/CD3+ (%)   40      31-60 % Final
        CD4+/CD3+ (Absolute)    674     410-1590 cumm   Final
        CD8+/CD3+ (%)   24      13-41 % Final
        CD8+/CD3+ (Absolute)    412     190-1140 cumm   Final
        CD4/CD8 Ratio   1.64    0.90-3.50       Final
        CD19 B Lymphs (%)       18      6-25 %  Final
        CD19 B Lymphs (Absolute)        343     90-660 cumm     Final
        NK Cells (%)    17      5-27 %  Final
        NK Cells (Absolute)     330     90-590 cumm     Final

T-cell function as measured by in vitro mitogen/antigen response is normal.

In my opinion, his immune function looks pretty good, but I am concerned with his low DHR on first measurement.  I've repeated and value came up into the normal range.  Is there anything else to look at?  Do I just treat his infections per episode or do you recommend prophylactic antibiotics?



Lynn A. Wiens, MD
Office: 918-495-2636
Cell: 918-550-1200
http://tulsaallergynews.com




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