[CIS PIDD] [cis-pidd] Hypergammaglobulinemia with low CD4

[CIS-PIDD]

Did the child receive Prevnar-7 and recent Pneumovax?  Were repeat titers done ( suggest 23 serotypes). Were the subtypes normal?  How high was the ESR?  Were there any polyps?  Was screening done for CF?  Were endoscopically directed cultures performed?  What was the balance of the CBC results including RBC and WBC morphology?  Was the anemia and elevated Fe worked up completely?  Folate levels? Any B12 supplements?  Diphtheria and Haemophilus titers?



Sincerely,

Wellington S. Tichenor, M. D.
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>



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________________________________
From: CIS-PIDD [cis-pidd at lists.clinimmsoc.org]
Sent: Sunday, November 06, 2016 10:09 AM
To: CIS-PIDD
Subject: [cis-pidd] Hypergammaglobulinemia with low CD4

Dear colleagues and experts:  I would like to obtain your input on an 8 years old male child with history of fatigue, recurrent infections (non-specific URIs, otitis and “sinus infections”) treated with antibiotics 2-4 times/year.
History of anemia, nonspecific joint pain, lack of concentration and focusing. No fevers
No other abnormal symptoms
FH +ve for atopic issues and sinus issues. No immunodeficiency
Normal exam multiple times (no eczema, lymphadenopathy, hepatosplenomegaly)
Labs:
persistent leukopenia (WBC 2.8-5.5)
Anemia—Hb 10-102, High ferritin -221-289, High vitamin B level >1500-2000
Elevated ESR normal CRP
Immunoglobulins----
IgG-1583-2170
IgA—417-522
IgM—55-78
Low lymphocyte count ----1100-1730
CD4---280-417
CD8----317-405
CD-19—310-420
NK cell( cd3 +) 92-98
Normal tetanus titers
Only 4/14 protective pneumococcal titers (pre vaccine)
Normal ANA profile (negative auto antibodies panel)
Negative for HIV
Normal thyroid functions
Summary; 8 years old fatigue, joint pains nonspecific upper respiratory infections with hypergammaglobinemia, leukopenia, lymphopenia, low CD4 count, high ferritin and elevated B12
Any guidance /input would be appreciated
Thanks

Ejaz Yousef MD
Nemours Children Clinic
Jacksonville, Fl


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