[PAGID] Patient with recurrent abscesses

[Belohradsky, Bernd Prof. Dr.]

acne inversa ? (of course, does not fit a girl aged 9 years; there might
be two different age-dependent diseases)
 
does she  and her family members carry S.aureus on their nasal mucosa
?(which may also occur  in 20-30% of the normal population, but not as a
continuous colonization) (you may try topic decontamination with
Turixin)
inocculations within the family (e.g. sharing towels, bathroom items
etc.) ?
 
are the abscesses located on body sites that she can reach with her
hands ? has she a paramedical profession ? even if the abscesses are not
polymicrobial, could it be a form of Muenchhausen syndrome ? (of course,
would not explain that it all started at age 9 years)
 
Bernd H.Belohradsky.MD
(Munich; University Childrens Hospital)

________________________________

Von: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] Im Auftrag von Abraham,
Roshini S., Ph.D.
Gesendet: Samstag, 19. Juli 2008 00:41
An: pagid at list.clinimmsoc.org
Cc: Rank, Matthew A., M.D.
Betreff: Re: [PAGID] Patient with recurrent abscesses



Thanks so much for the responses below...........

 

To answer Tom's question - IgE levels are = 424 KU/L

 

She has no disseminated infections or pneumatoceles.

 

Thank you for the suggestion regarding hidradenitis............Dr. Rank
had considered it but thought against since she had abscesses on her
stomach, behind the ears and on the arms...which were unusual locations
and also they occurred in clusters.....in fact, her present groin
lesions are also several in number.

 

We will check MBL levels.

 

Thanks again for the feedback.

 

Roshini

 

 

Matthew Rank, MD

Roshini Abraham

Mayo Clinic

 

 

 

 

 

 

 

________________________________

From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Saxon, Andy M.D.
Sent: Friday, July 18, 2008 1:40 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] Patient with recurrent abscesses

 

Beware of Hidradenitis Suppurativa, Groin, under arms and under breast
would be typical. Behind ears/arms unusual. It is far more common than
primary ID and is often overlooked. I saw more of this than hyper IgE ID
in way of referral. 

 

Andy Saxon, MD

Professor Emeritus (I love writing that), currently on "re-hire"

UCLA School of Medicine.

 

________________________________

From: pagid-bounces at list.clinimmsoc.org
[mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Berger, Melvin
Sent: Friday, July 18, 2008 10:47 AM
To: pagid at list.clinimmsoc.org
Subject: RE: [PAGID] Patient with recurrent abscesses

The infections have never disseminated ?  Has she had pneumatoceles ?

 

I would check mannan binding lectin. 

 

Melvin Berger, M.D., Ph.D.

Professor of Pediatrics and Pathology

Case Western Reserve University

phone 216 844 3237

 

Director, Jeffrey Modell Center for Primary Immune Deficiencies

Division of Allergy-Immunology

Rainbow, Babies and Children's Hospital

University Hospitals of Cleveland

RB&C Rm 504, MS 6008B

11100 Euclid Ave.

Cleveland, OH 44106

 

________________________________

From: pagid-bounces at list.clinimmsoc.org on behalf of Fleisher, Thomas
(NIH/CC/DLM) [E]
Sent: Fri 7/18/2008 1:29 PM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] Patient with recurrent abscesses

What is her IgE level?

 

Thomas A. Fleisher, M.D.

Chief, Department of Laboratory Medicine

NIH Clinical Center

tel 301 496-5668

fax 301 402-1612

email tfleishe at mail.nih.gov

 

________________________________

From: Abraham, Roshini S., Ph.D. [mailto:Abraham.Roshini at mayo.edu] 
Sent: Friday, July 18, 2008 1:15 PM
To: pagid at list.clinimmsoc.org
Cc: Rank, Matthew A., M.D.
Subject: [PAGID] Patient with recurrent abscesses

 

We have a 43 year old woman from the Northwest United States that has
had recurrent staphylococcal abscesses (non-MRSA) since age 9.  These
have been located in her groin, under and on her arms, abdomen, behind
her ear and generally develop within 12-24 hours.  She has required
multiple incision, drainage, and packing procedures and has take
prophylactic antibiotics without significantly decreasing the frequency
of their occurrence.  She is otherwise healthy except for cigarette
smoking, peripheral vascular disease, urinary stress incontinence, and
irritable bowel syndrome.  She denies eczema.  Her father, his sisters,
and her paternal grandmother all have the same problem though to a
lesser degree.  Physical exam is notable only for 1 cm pink raised
lesions in her groin area, none are actively draining or fluctuant.  Her
immune testing to date includes normal IgA, IgM, and IgG.  She has had a
normal oxidative burst test and normal neutrophil chemotaxis.  She does
not have anemia, thrombocytopenia or neutropenia.  Her ALC is also
normal.  No evidence of respiratory or other infections,
lymphadenopathy, malnutrition etc.  

 

We would appreciate your comments and advice.

 

 

Mathew A. Rank, MD, Mayo Clinic, Rochester, MN

Roshini S. Abraham

 

 

 

 

 

 

 

 

Roshini Sarah Abraham, Ph.D., D(ABMLI)

Consultant, Div. of Clinical Biochemistry & Immunology
Assistant Professor of Medicine & Lab. Medicine & Pathology 
Director 
Cellular and Molecular Immunology Laboratory 
Department of Laboratory Medicine and Pathology 
Hilton 210 e 
Mayo Clinic 
200 1st St SW 
Rochester, MN-55905 
Ph: 507-266-9292 
Ph (Secy): 507-284-4055 
Fax: 507-266-4088 

 


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