Q:

9/9/2013
47 year-old male with long standing history of AR, asthma, eczema, intermittent lower GI cramping/discomfort. In addition to his symptoms he has elevated IgE(1819), borderline low WBC for years (around 3.0 k/Ul). He has also had slightly elevated eosinophils but all under 600. Recent colonoscopy with diverticulosis, focal erosion and hemorrhage on sigmoid colon via biopsy no malignancy or dysplasia. On CBC . He has seen GI, Rheumatology, and Hematology. Various blood tests WNL (HIV, SPEP, ANCA, IgG, IgA, IgM, various autoantibodies). His most recent CRP is elevated at 25.7 mg/L. He has no recurrent infections aside from one episode of epididymitis (etiology?) and a couple episodes of diverticulitis. He is currently on Xolair (off inhaled steroids), AIT, Lexapro, SABA PRN, Veramyst, antihistamines PRN, Various topical steroids (derm RX). GI started Apriso to see if would help GI sx despite negative w/u for inflammatory bowel disease. Eczema remains out of control. Is there something I'm missing that may tie the GI complaints, low WBC and severe atopy eczema together?

A:

Thank you for your inquiry.

In short, no, I cannot think of any single entity that would account for the multiplicity of problems that your patient has, and I could find nothing on a literature search that approximated his description. But I would mention parenthetically that it is interesting to note that lay message boards (that you can access by Googling “low white blood cell count and elevated IgE”) have several patient-reported instances of elevated IgE and a low white count. Nonetheless, of course, there is no way to interpret the significance of these anecdotal reports.

In sum, I think that you have done due diligence, and I am not aware of any described single condition that fits your patient, and cannot suggest any further evaluation.

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology