[CIS PIDD] [cis-pidd] chronic rhinosinusitis in ADA SCID patient

[CIS-PIDD]

Has he had surgery? Does he have nasal polyps?  Has he been tested for CF?  Were fungal cultures done? mycobacteria (See http://wwwnc.cdc.gov/eid/article/18/10/12-0164_article.htm)? anaerobes?  What does the gram stain show?  Are there polys or eos?  You may need to increase IgG to even higher levels.  What does he use for lavage?  Neilmed bottles will become contaminated quickly.

There is debate about adequacy of Augmentin penetration into the sinuses by ID.  Has he been on budesonide drops? What other medications is he on? ( omalizumab, montelukast, zileuton ?)


Sincerely,

Wellington S. Tichenor, M. D., FAAAI
642 Park Avenue
New York, New York 10065
212 517-6611
wtichenor at sinuses.com<https://register.concentric.com/home/apps/mail/mbox_compose.cgi?pTo=wtichenor@sinuses.com>




________________________________
From: CIS-PIDD [cis-pidd at lists.clinimmsoc.org]
Sent: Wednesday, May 25, 2016 5:16 PM
To: CIS-PIDD
Subject: [cis-pidd] chronic rhinosinusitis in ADA SCID patient

Dear colleagues,

I am seeking input on a teenage ADA SCID patient (s/p non-conditioned haplo BMT with persistent T cell lymphopenia) with chronic rhinosinusitis.  He has been on multiple rounds of culture-directed oral antibiotics with fair response.  His sinus CT demonstrates mild mucosal thickening.  Scoping by ENT demonstrates persistent purulence with cultures growing H. influenzae type A beta-lactamase negative and sensitive to all testing antibiotics except TMP/SMX.  He has been treated repeatedly with augmentin and is a highly adherent patient.  His monthly IVIG dose has been increased with most recent IgG trough 944 mg/dl.  Intranasal steroids have been tried (OMCs are patent). He does nasal lavage with sterile normal saline 2x/daily.

He has fair response to oral antibiotics and has a history of severe C. Diff colitis.  His quality of life is not bad, but he has frequent sore throat. occasional cough, and intermittent serous OM.

Are any of you aware of new approaches to this common problem in our patient population or can share anecdotal successes?

Thank you


Christine M. Seroogy MD,  FAAAAI
Associate Professor
University of Wisconsin School of Medicine and Public Health
Department of Pediatrics
Division of Allergy, Immunology & Rheumatology
1111 Highland Avenue
4139 WIMR
Madison, WI  53705-2275
phone: 608-263-2652
fax: 608-265-0164






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