Coffee-Talk with Dr. Bukstein and Friends with guest Dr. Dennis Ledford
Case Preview:
Case 1: 48 y/o WF presents with syncopal episode following an unknown sting or bite while attending a family picnic. She had erythematous skin, no wheeze and blood pressure was 82/46 mm Hg with tachcardia and no wheeze. She recovered spontaneously and was taken to ED for observation and discharged after 8 hours. She has a 5 year history of flushing and periodic abdominal distension with nausea. Blood pressure is consistently low between episodes and does not change during symptoms. Duration of symptoms and signs usually 24-72 hours and resolve with supportive care. Her father has had episodic abdominal pain with suspicion of pancreatitis but he has discontinued drinking alcohol. He has experienced events without drinking.
Case 2: 52 y/o WF is referred to you by ENT colleague for recurrent sinusitis with prior surgery. CT imaging demonstrates pansinusitis. She does not have a history of pneumonia but has been treated for bronchitis, averaging 1-2 episodes per 12 months. Her bronchitis is treated with oral antibiotics, usually oral corticosteroids and frequently with bronchodilators and sometimes with inhaled corticosteroids. She is nonsmoker. Spirometry shows restrictive disease with FEV1 of 70% predicted and no reversibility. FeNO is 18 ppb. Chest radiograph is normal.
Case 3: 26 y/o WF referred by gastroenterologist for abnormal immunoglobulins. She has 10 year history of abdominal pain, bloating, diarrhea without hematochezia or nocturnal symptoms. Gluten free diet improved symptoms. Endoscopy is negative and celiac testing reveals: -IgA 22 mg/dl -IgG 650 mg/dl -IgM 20 mg/dl -TTG IgA Neg -TTG IgG Neg. -She was told that she does not have celiac disease but immunodeficiency may be causing her symptoms