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

[CIS-PIDD]

Dr. Kumar:

If you haven't yet, do send a few sputum samples for AFB stain and culture.  My pulmonology colleagues are getting weirder and werider stuff from their immunodeficient patients.  Just had a rather long academic conversation on how an AFB that all the textbooks say is a contaminant (this was Mycobacterium gordonae)  should be considered a true pathogen once it grew in 3 out of 3 samples.

For the eye gook (this is the technical term?), I would suggest culturing and sending a PCR for adenovirus (at least).  We don't know if we don't check.

Good luck.

   - 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 at lyris.dundee.net [cis-pidd at lyris.dundee.net] on behalf of CIS-PIDD [cis-pidd at lists.clinimmsoc.org]
Sent: Thursday, April 13, 2017 11:10 AM
To: CIS-PIDD
Subject: Re: [cis-pidd] XLA, Bronchiectasis, Chronic sinsusitis

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<mailto: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


--
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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