[CIS PIDD] [cis-pidd] Steroid-responsive Dysuria in CGD

[CIS-PIDD]

Dr.  Church:

First thought ... could the toddler be faking?  Of course, this is a diagnosis of exclusion and all ... but it's always a possibility with children.

Is there anything objective that suggests that there might be a problem?  A positive urine sediment?  positive urine culture?  fever?  Or, could this be constipation-related (transient) urinary obstruction?  If the U/A is positive, I would be curious if the boy would have actually had a urethritis or a cystitis.  

And, of course, if there has been any travel (anywhere within the vicinity of certain African lakes), then the D/Dx would take a left turn.

May I ask ... how did steroids enter the picture to begin with?

  - Karl

Karl O. A. Yu, M.D., Ph.D., F.A.A.P.
Instructor of Pediatrics (Pediatric Infectious Diseases)
University of Chicago - Comer Children's Hospital
5841 S Maryland Ave, MC 6054, Chicago IL 60637
Pager:  773-702-6800   x1744
Fax:  773-702-1196
Lab phone (Bubeck Wardenburg laboratory): 773-834-6976


________________________________________
From: CIS-PIDD [cis-pidd at lists.clinimmsoc.org]
Sent: Friday, October 21, 2016 5:37 PM
To: CIS-PIDD
Subject: [cis-pidd] Steroid-responsive Dysuria in CGD

Colleagues:

I follow an 18 month old boy with X-CGD.  He seems to have dysuria that is responsive within a day or two to systemic steroids.  He has had a normal procto-colonoscopy and most recently normal cystoscopy with biopsies negative for inflammation and with no visual evidence of obstruction in the lower urinary tract.

What am I missing?

Joe Church
Children’s Hospital Los Angeles

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