[CIS PIDD] [cis-pidd] Recurrent hand, foot and mouth disease with normal immune work up.

[CIS-PIDD]

Dear colleagues and experts: I would like to get your help on the following case:


2-1/2-year-old with history of 4 episodes of hand, foot and mouth disease (in August 2015, September 2015, 08/01/2016 and 09/03/2016). Each episode presented with vesicles on the hands, feet and in the mouth associated with fever. The patient had a nasal swab on 09/01/2016 that showed enterovirus. The patient was evaluated in this clinic on 09/19/2016 and had immune work up that came back normal. Since last visit, John has done well without any medical problems till 01/07/2017, when he developed fever and vesicular rash on the hands, feet and the tongue.

Past Medical History: The patient was born prematurely at 33 weeks' gestation and he stayed in the NICU for 8 weeks and he was diagnosed with apnea and bradycardia and gastroesophageal reflux. He has asthma and allergic rhinitis and he had recurrent illnesses and had tympanostomy tubes placement in March of 2016.



Laboratory evaluation: On 09/19/2016, IgE 6, IgG: 598, IgA: 53, IgM: 74, IgG 1: 372 , IgG2: 85, IgG3: 42, IgG4: 3.7, white blood cell count: 10.6, poly 31%, lymph 57%, mono 8%, hemoglobin: 12.4, hematocrit: 36.6, platelets count: 422, Tand B cell subsets normal, pneumococcal titer with no response and tetanus antibody 1.56.

Impression: Recurrent hand, foot and mouth disease with normal immune work up.

Any suggestion regarding  any further work up would be appreciated

Ejaz Yousef MD

Nemours Children Specialty Care

Jacksonville, FL



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