[CIS-PAGID] multifocal pneumococcal abcesses in a 6-week old infant

[Brooks, Edward G]

Posted for Tony Infante, any thoughts would be appreciated.

CC: a six week old female infant with multifocal osteomyelitis and abscesses
HPI: She presented to her local pediatrician with expanding anterior chest wall mass at one month of age. The mass was somewhat fluctuant but not particularly erythematous or warm. Imaging studies revealed a lytic lesion in an underlying rib. Surgical incision and drainage of mass and needle aspiration of rib lesion were done and sent for cultures which promptly yielded a heavy growth of Strep. pneumoniae. The patient was treated with appropriate antibiotics. After transfer to our hospital, additional lytic lesions were found in the paraspinal and pelvic regions. In retrospect, these were probably present on previous imaging. These were also drained of copious pus.
PMH: 36 week gestation, spent one day under bili-lights.
FH: five siblings ranging up to 9 years of age, all alive and well. Parents deny any similar illnesses.
Exam: A slightly underweight, but normal appearing infant in no acute distress. Surgical scars and dressings were present. No evidence of additional cutaneous, subcutaneous or other infections. No signs of upper or lower respiratory tract infection. No oral thrush. No skin rash. No lymphadenopathy or hepatosplenomegaly.
Labs: CBC showed modestly elevated neutrophils, normocytic anemia, normal platelet and lymphocyte counts. Immunoglobulin classes and complement levels were normal for age. Flow cytometry showed adequate levels of T, B and NK cell numbers, although CD4/CD8 ratio was inverted (0.5). HIV1/2 was non-reactive. Neutrophil oxidative burst by flow cytometry (DHR) was normal. CD11/CD18 levels were normal. TLR assay done by ARUP was normal. Arrangements have been made for genetic/genomic studies in Dr. J-L Casanova's lab.


Edward G. Brooks, MD
UTHSCSA, Dept. of Pediatrics
Division of Immunology and Infectious Disease, Rm. 528L
7703 Floyd Curl Drive
San Antonio, Texas 78229-3900
brookse at uthscsa.edu
tel: 210-567-5250
fax: 210-567-6305

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