[PAGID] Helicobacter/Flexispira cellulitis in XLA

[Howard Lederman]

I have experience with two such cases, the first of which was published (Simons et al;  Infection.<javascript:AL_get(this,%20'jour',%20'Infection.');> 2004 Dec;32(6):367-8).  That pt was treated with a two-week course of gatifloxacin (5 days IV + 9 days po) with resolution of all skin lesions, but they recurred two weeks later.  He eventually was cured with a 6 wk course of IV gentamicin and imipenem.    The second pt was also treated with a long course of 2 drugs IV.

If your pt has had the rash for a long time, you might want to consider imaging the underlying bone to look for osteomyelitis.

Howard M. Lederman, M.D., Ph.D.
Professor of Pediatrics, Medicine and Pathology
Division of Pediatric Allergy and Immunology
Johns Hopkins Hospital - CMSC 1102
600 N. Wolfe Street
Baltimore, MD 21287-3923
Phone: 410-955-5883
Fax: 410-955-0229
Email: Hlederm1 at jhmi.edu<mailto:Hlederm1 at jhem.jhmi.edu>

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From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Turvey, Stuart
Sent: Wednesday, June 16, 2010 3:18 PM
To: pagid at list.clinimmsoc.org
Subject: [PAGID] Helicobacter/Flexispira cellulitis in XLA

Dear Colleagues,
I am writing to explore your collective wisdom in planning treatment for a 15 yo boy with X-linked agammaglobulinemia (XLA) who has chronic lower leg cellulitis likely due to infection with a Helicobacter/Flexispira organism.
Briefly, for the past year has had a worsening skin rash/cellulitis on his lower extremities. The swelling and erythema have fluctuated and at times have had an appearance consistent with erythema nodosum. Over time the skin has become 'woody' and indurated. Careful examination of a recent skin biopsy revealed curvilinear rods, and plans are in place for a repeat biopsy with special cultures and 16S ribosomal RNA sequencing to confirm the microbiological diagnosis.
I would appreciate any advice on an optimal antibiotic treatment plan. A major complication is that the family live on a beautiful, but remote island off the northwest coast of British Columbia, Canada.....so a simple but effective antibiotic schedule would be preferable.
Thank you in advance for your input.
Stuart Turvey

Stuart Turvey MB BS DPhil
Associate Professor
Division of Infectious and Immunological Diseases
University of British Columbia
BC Children's Hospital and Child & Family Research Institute
950 West 28 Avenue
Vancouver BC V5Z 4H4
Canada
Ph: 604 875 2345 x5094
Fax: 604 875 2226
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