[CIS PIDD] [cis-pidd] Laryngeal papilomatosis in boy with CGD awaiting BMT

Sun Mar 12 17:13:30 EDT 2017

Am I the only person wondering if child protection should be involved in oral HPV in a 9 yo boy?  

Kathy Haines

-----Original Message-----
From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org] 
Sent: Saturday, March 11, 2017 7:45 PM
To: CIS-PIDD <cis-pidd at lyris.dundee.net>
Cc: jaime inostroza <jaimel.inostroza at gmail.com>
Subject: Re: [cis-pidd] Laryngeal papilomatosis in boy with CGD awaiting BMT

If the sender shows as an internal Hackensack Meridian email address forward the email to Information.Security.Office at HackensackMeridian.org

Note, THIS IS AN EXTERNAL EMAIL. It did not originate at Hackensack Meridian Health Network.

----------------------------------------------------------------------

Sent from my iPhone

> On Mar 11, 2017, at 7:23 PM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org> wrote:
> 
> Dear Jane
> 
> I am writing on behalf of Dr. Jaime Inostroza,  director of the Jeffrey Modell Center for Diagnosis  and Research in primary immunodeficiencies in Temuco, Chile. I mentioned your question to him because I was aware of an upcoming publication by his team.
> 
> They evaluated  a 7-yer-old boy with chronic recurrent laryngeal papilomatosis requiring multiple surgeries since infancy. No immunodeficiency was identified. A biopsy of his lesions confirmed the presence of HPV serotype 6. Based on several publications about the use of the tetravalent HPV vaccine at 9 years of age this boy received 3 doses of Gardasil. The second and third doses were given at 6 mo intervals. His papilomatosis has cleared completely for the first time in his life. He leads now a normal life and has remained free of recurrences  for over 1 year. This patient case will be published now in the Chilean Journal of Pediatrics. I am requesting the English abstract and references in case you are interested.
> 
> CGD patients have normal antibody and cell mediated immunity and usually have normal responses to vaccines. You could consider the therapeutic use of HPV for your patient. 
> 
> Ricardo Sorensen, M.D.
> Clinical Professor of Pediatrics
> LDU Health Science Center and Children’s Hospital, New Orleans Head, 
> Jeffrey Modell Center for Diagnosis and Research in New Orleans 
> Honorary Professor, Universidad de la Frontera. Temuco, Chile
> 
> -----Original Message-----
> From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org]
> Sent: Saturday, March 11, 2017 5:39 AM
> To: CIS-PIDD
> Subject: RE:[cis-pidd] Laryngeal papilomatosis in boy with CGD 
> awaiting BMT
> 
> *EXTERNAL EMAIL: EVALUATE*
> 
> 
> Dr. Peake:
> 
> We've had some decent experience with nebulized cidofovir.   See Giles et al., Ped Resp Rev 2006.
> 
> The more curious question is why an XL-CGD patient would have -- assuming it's confirmed as HPV positive -- a recurrent viral infection.
> 
> Good luck with this case. 
> 
>   - K
> 
> Karl O. A. Yu, M.D., Ph.D., F.A.A.P.
> Section of Infectious Diseases  |  Department of Pediatrics  |  Comer 
> Children's Hospital  |  University of Chicago
> 5841 S Maryland Ave,  MC 6054,  Chicago  IL  60637 Office phone: 
> 773-702-9281  |  Pager: 773-702-6800 x1744  |  Fax: 773-702-1196
> 
> ________________________________________
> From: CIS-PIDD [cis-pidd at lists.clinimmsoc.org]
> Sent: Thursday, March 09, 2017 5:40 AM
> To: CIS-PIDD
> Subject: [cis-pidd] Laryngeal papilomatosis in boy with CGD awaiting 
> BMT
> 
> Dear all
> I was wondering if anyone could help with a patient we have?
> 
> We have a 13yo boy with X-linked CGD (previous liver abscess, pulmonary aspergillosis, chronic lung disease) who we were working up for BMT. He has had some palatal ulcers (biopsy - granuloma; extensive microbiological workup revealed no organism) and multiple lymph nodes in his neck for a number of months.  He was admitted prior to transplant to improve nutrition and to investigate some potential foci of infection. In the workup for transplant he was noted to have on MRI asymmetric but circumferential thickening of the soft palate, uvula, palatine tonsils, oropharyngeal mucosal space, epiglottis, aryepiglottic folds, larynx and larynopharynx. PET scan showed diffuse moderate to intense FDG uptake in the same areas. On initial bronchoscopy he was noted to have some supraglottic nodules which were presumed to be granulomas and were not biopsied. A course of steroids were commenced with prednisone 1mg/kg given for 10 days then weaned over the following 3 weeks. He then started to get increasing problems with his upper airways with production of a lot of purulent mucus (no growth) and some difficulty swallowing. On repeat  laryngoscopy he was found to have diffuse severe papillomatosis of the whole of the larynx with copious overlying purulent exudate. Histology would be consistent with papillomatosis and is p16 positive and we are awaiting PCR for HPV. He responded well initially to debridement and relatively high dose dexamethasone (he already was covered with broad spectrum antibiotics and ambisome). Due to a rapid return of his supraglottic and glottic swelling which followed weaning of his steroids and cessation of antibiotics (no bacterial growth), he is to have further debridement tomorrow just 2 weeks after this was first undertaken.
> 
> Has anyone encountered HPV this in this setting? If so, what treatments have you tried? What about BMT with  laryngeal papillomatosis ?
> 
> Any help or suggestions greatly appreciated
> 
> Kind regards
> 
> Jane
> 
> Associate Professor Jane Peake
> Paediatric Immunologist and Allergist
> Discipline of Paediatrics & Child Health School of Medicine | The 
> University of Queensland Lady Cilento Children's Hospital| 501 Stanley 
> Street | South Brisbane QLD 4101
> 
> 
> ---
> 
> You are currently subscribed to cis-pidd as: karl.yu at uchospitals.edu<mailto:karl.yu at uchospitals.edu>.
> To unsubscribe click here: 
> https://urldefense.proofpoint.com/v2/url?u=http-3A__cts.dundee.net_u-3
> Fid-3D102579666.a83334013fa83578294535dc926fb7d0-26n-3DT-26l-3Dcis-2Dp
> idd-26o-3D4244739&d=DwIGaQ&c=lC2BOuyTwLhYUwx2vqZp6A4NC8GJH--j-GtKaBDeE
> wM&r=LBCNNFGAS5HkbLNCSEWo68t4r0H3VQgB0OuVnfWlR3kkXk2Q_V4zvCwqbFUnsqLd&
> m=jHFdWxhAlrAKXdDFvsg5GGBPPVBUk-tgXgOHAU5YG0M&s=wQ9BxOxtj1pjtO38SiSFyh
> ndPKNX_KT6Rla-SFm8V2U&e= (It may be necessary to cut and paste the 
> above URL if the line is broken) or send a blank email to 
> leave-4244739-102579666.a83334013fa83578294535dc926fb7d0 at lyris.dundee.
> net<mailto:leave-4244739-102579666.a83334013fa83578294535dc926fb7d0 at ly
> ris.dundee.net>
> 
> 
> ---
> You are currently subscribed to cis-pidd as: rsoren at lsuhsc.edu.
> To unsubscribe click here: 
> https://urldefense.proofpoint.com/v2/url?u=http-3A__cts.dundee.net_u-3
> Fid-3D96396872.ade83bbd1f26603d33d3160b249a1880-26n-3DT-26l-3Dcis-2Dpi
> dd-26o-3D4249233&d=DwIGaQ&c=lC2BOuyTwLhYUwx2vqZp6A4NC8GJH--j-GtKaBDeEw
> M&r=LBCNNFGAS5HkbLNCSEWo68t4r0H3VQgB0OuVnfWlR3kkXk2Q_V4zvCwqbFUnsqLd&m
> =jHFdWxhAlrAKXdDFvsg5GGBPPVBUk-tgXgOHAU5YG0M&s=fiMP-MwFkxjY-CIBSYGyC1o
> cNvZy7cpU0TN084tiBOE&e= or send a blank email to 
> leave-4249233-96396872.ade83bbd1f26603d33d3160b249a1880 at lyris.dundee.n
> et
> 
> ---
> You are currently subscribed to cis-pidd as: donald.vinh at mcgill.ca.
> To unsubscribe click here: 
> https://urldefense.proofpoint.com/v2/url?u=http-3A__cts.dundee.net_u-3
> Fid-3D96396489.ee3cfbd17fe20d856fceefd1e4cb5f29-26n-3DT-26l-3Dcis-2Dpi
> dd-26o-3D4250089&d=DwIGaQ&c=lC2BOuyTwLhYUwx2vqZp6A4NC8GJH--j-GtKaBDeEw
> M&r=LBCNNFGAS5HkbLNCSEWo68t4r0H3VQgB0OuVnfWlR3kkXk2Q_V4zvCwqbFUnsqLd&m
> =jHFdWxhAlrAKXdDFvsg5GGBPPVBUk-tgXgOHAU5YG0M&s=74lYb02EW9BB3lHN0-63t4H
> HyGgkTUIBIaSEgCks5hg&e= or send a blank email to 
> leave-4250089-96396489.ee3cfbd17fe20d856fceefd1e4cb5f29 at lyris.dundee.n
> et

---
You are currently subscribed to cis-pidd as: Kathleen.Haines at hackensackmeridian.org.
To unsubscribe click here: https://urldefense.proofpoint.com/v2/url?u=http-3A__cts.dundee.net_u-3Fid-3D96396731.74f8a6157293134d1badf495b212a19e-26n-3DT-26l-3Dcis-2Dpidd-26o-3D4250106&d=DwIGaQ&c=lC2BOuyTwLhYUwx2vqZp6A4NC8GJH--j-GtKaBDeEwM&r=LBCNNFGAS5HkbLNCSEWo68t4r0H3VQgB0OuVnfWlR3kkXk2Q_V4zvCwqbFUnsqLd&m=jHFdWxhAlrAKXdDFvsg5GGBPPVBUk-tgXgOHAU5YG0M&s=7G9xeDzbGGxYTqPim9-hJCWVjREdLjnwrTwl3k6eij4&e=
or send a blank email to leave-4250106-96396731.74f8a6157293134d1badf495b212a19e at lyris.dundee.net

-------------------------------------------------------------------------
This message was secured by ZixCorp(R).

---
You are currently subscribed to cis-pidd as: pagid at list.clinimmsoc.org.
To unsubscribe click here: http://cts.dundee.net/u?id=96396833.5a9591ccd1e327fe6bc4d1543298c482&n=T&l=cis-pidd&o=4251393
or send a blank email to leave-4251393-96396833.5a9591ccd1e327fe6bc4d1543298c482 at lyris.dundee.net