[CIS PIDD] [cis-pidd] XLA, Bronchiectasis, Chronic sinsusitis

[CIS-PIDD]

Santhosh,
1. You don't say what you are doing for chest PT or how bad the
bronchiectasis is. I would have him use a flutter valve at least twice a
day but a CPT vest would be better. You might consider a pulmonary lavage.
I would push his IgG trough to at least 1000.
2. What does his sinus CT look like at this point.
3. The yellow mucus is probably coming from the nose/sinuses retrograde
through the NL duct. How often does he use saline nasal irrigation? Have
you ever added antibiotic to the nasal lavage fluid (e.g., Cipro
500mg/500ml)?
Richard Wasserman
Dallas

On Thu, Apr 13, 2017 at 10:48 AM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
wrote:

> Hi Everyone,
> Any thoughts regarding this case is greatly appreciated.
>   I have a now 8-year-old male with XLA (BTK gene mutation confirmed) on
> IVIG replacement.  He has bronchiectasis in the lower lobes, chronic
> rhinosinusitis status post sinus surgery x 1. His trough IgG level have
> been >800mg/dl.
>
> My questions are:
> 1. Pt has had chronic cough likely related to his bronchiectasis and his
> chronic rhinosinusitis and we have been unsuccessful in treating it in
> spite of doing chest physical therapy, asthma controller medication, sinus
> surgery, saline rinse, Tobramycin rinse. Pt has been treated with multiple
> courses of antibiotics in the past with no significant relief of symptoms.
> ENT is recommending one more sinus surgery but I am hesitant as the first
> one did not help. His direct sinus cultures have not yielded much except
> for occasional scant growth of H.Influence.  Anything else we could do to
> help this little guy.
>
> 2. He also has this weird history of yellow mucus coming from his eyes on
> and off with evidence of conjunctival injection. This discharge is more
> visible when he sneezes and coughs. He was checked by an ophthalmologist
> who ruled out lacrimal duct obstruction. ENT thinks this is related to his
> chronic sinusitis and the constant yellow drainage he has in his nose. Any
> thoughts?
>
> Thank you,
>
> Santhosh Kumar, MD, FAAAI
> Assistant Professor
> Children's Hospital of Richmond at VCU
> VCU Heath
> Richmond, VA
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-- 
Richard L. Wasserman, MD, PhD
Allergy Partners of North Texas
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211

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