[CIS PIDD] [cis-pidd] Patient for list.
CIS-PIDD
cis-pidd at lists.clinimmsoc.org
Wed Jan 6 11:10:39 EST 2016
Hi Lyn,
Does there appear to be any evidence of diabetes or vascular insufficiency in this patient? These could also predispose to the types of infections you described.
Dr. Victoria Cook PGY-4
Allergy and Clinical Immunology
University of British Columbia
41-01536
On Jan 6, 2016, at 8:01 AM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>> wrote:
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<http://tulsaallergynews.com/>
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