HIV in Children
GRAND ROUNDS AND TEACHING FILES
Is it NK cell deficiency?
Ira Shah
Consultant in Pediatric Infectious Diseases and Pediatric Hepatology, Nanavati Hospital, Mumbai, India
Incharge, Pediatric HIV and TB Clinic, B J Wadia Hospital for Children, Mumbai, India

A 35 day old girl was referred to the orthopedic department with decreased movement and pain of the left leg since 1 week. On examination, the child had a left knee synovitis. Synovial tap was done which was sterile. However, post aspiration, the child went into cardio-respiratory arrest and was shifted to the ICU. The child was intubated and required ventilatory and ionotropic support. She required multiple blood transfusion and packed cell transfusion. She also had 3 episodes of seizures and was treated with anticonvulsants. In the ICU, she was detected to have right upper lobe pneumonia and was treated with IV antibiotics but showed no response. She was gradually weaned of the ventilator and ionotropic support. She was 2.5 kg. Her Chest X-Ray revealed bilateral haziness. She received antibiotics for 4 weeks but the lungs remained the same. Her HRCT chest showed bilateral lower zone atelectasis with bronchopneumonia.

Birth History: She was a preterm LSCS delivery with birth weight of 1.5 kg and required NICU stay for 10 days for preterm care.

Investigations: Her hemogram showed WBC count of 9,400 with 68% polymorphs and 32% lymphocytes with normal platelet count. In view of persistent pneumonia, an underlying immunodeficiency was suspected. HIV ELISA was negative. Serum immunoglobulins were IgA = 25 mg/dl, IgG = 719 mg/dl and IgM = 235 mg/dl. Her CD panel showed CD3 = 2439 /cumm [2300-6000], CD4 = 1172 [1500-5000], CD8 = 1112 [500-1500], CD19 = 1097 [600-3000], CD16 = 18%, CD56 = 0%, and CD20 = 22% suggestive of Non Killer (NK) cell deficiency. Her GER test was negative. CMV IgM was negative whereas CMV IgG was 12 (positive). Gastric lavage for PCP and fungal was negative. Blood Bactec resin culture was negative. She was continued on oral antibiotics and asked to follow up regularly with advice to avoid live vaccines.


Is this NK cell deficiency?
See Previous Teaching Files
Pediatric Oncall Book Store
NEW ARRIVAL
Infection in Children - Part 2

By Dr. Ira Shah
Case Rounds in Pediatric Liver Disorders
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Tuberculosis
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Management of Pediatric HIV
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Infection in Children
By Dr. Ira Shah