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

[CIS-PIDD]

He has not had a directed work-up for either. I'll pursue with PCP. Thanks for the input.

Lynn A. Wiens, MD
Warren Clinic
http://tulsaallergynews.com
Cell: 918-550-1200

From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org]
Sent: Wednesday, January 06, 2016 10:11 AM
To: CIS-PIDD
Subject: Re: [cis-pidd] Patient for list.

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.
_<x-msg://3/name=>
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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