[PAGID] FW: [Fwd: Re: Patient with recurrent abscesses]

[Grimbacher, Bodo (Medsch Hampstead/Immunology)]

Dear Roshini, dear Matthew,
Recurrent skin abscesses are a common reason for referrals in the adult
PID setting and often we do not find anything.
I am attaching out RFH protocol we have implemented for these patients,
I hope it is of any help.
Yours, Bodo

-----Original Message-----
From: Bodo Grimbacher [mailto:bodo.grimbacher at uniklinik-freiburg.de] 
Sent: 16 August 2008 11:41
To: Grimbacher, Bodo (Medsch Hampstead/Immunology)
Subject: [Fwd: Re: [PAGID] Patient with recurrent abscesses]



-------- Original-Nachricht --------
Betreff: 	Re: [PAGID] Patient with recurrent abscesses
Datum: 	Sat, 19 Jul 2008 10:27:28 +0200
Von: 	Belohradsky, Bernd Prof. Dr.
<Bernd.Belohradsky at med.uni-muenchen.de>
Antwort an: 	pagid at list.clinimmsoc.org
An: 	<pagid at list.clinimmsoc.org>
CC: 	Rank, Matthew A., M.D. <Rank.Matthew at mayo.edu>



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


----------------------------------------------------------
IMPORTANT WARNING: This email (and any attachments) is only intended for

the use of the person or entity to which it is addressed, and may 
contain information that is privileged and confidential. You, the 
recipient, are obligated to maintain it in a safe, secure and 
confidential manner. Unauthorized redisclosure or failure to maintain 
confidentiality may subject you to federal and state penalties. If you 
are not the intended recipient, please immediately notify us by return 
email, and delete this message from your computer.
----------------------------------------------------------



-------------- next part --------------
A non-text attachment was scrubbed...
Name: Recurrent Cutaneous Abscesses version 1.doc
Type: application/msword
Size: 74752 bytes
Desc: Recurrent Cutaneous Abscesses version 1.doc
Url : <http://seven.pairlist.net/mailman/private/pagid/attachments/20080818/c07b2561/attachment-0001.doc>