[CIS-PAGID] Recalcitrant buttock ulcer in a 2yo with X-linked CGD

[Sullivan, Kathleen]

You really can't go wrong with the topical GM-CSF.  It is expensive but there is almost no risk.

Kate
On May 9, 2011, at 12:53 PM, Turvey, Stuart wrote:


> Dear Colleagues,

> 

> I would value your input on a patient here in Vancouver, Canada.

> 

> We recently diagnosed a 2yo boy with X-linked chronic granulomatous disease (CGD) and we are moving toward HSCT.

> 

> Unfortunately, we have had trouble clearing up a lesion on his left buttock. Approximately 6 months ago this lesion began as a small ‘boil’ which ultimately broke down and drained pus. We are now left with a ~1.5cm diameter ulcer with a slightly rolled edge, base with granulation tissue and minimal surrounding erythema (see attached image).

> 

> The unsuccessful steps we have taken to heal this lesion have included:

> i) Biopsy with extensive culturing and histological examination: no organisms identified

> ii) 10 days empiric antimicrobial therapy with meropenem, vancomycin and caspofungin: no change

> iii) 14 days prednisone (1mg/kg/day divided BID): no change

> iv) Careful wound care and dressings

> 

> What should we do next? We are considering topical GM-CSF, but no one here has any experience with this approach.

> 

> We really want to get this lesion cleared up before transplantation.

> 

> I thank you in advance for your input.

> 

> Stuart

> 

> 

> 

> 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

> Ph: 604 875 2345 x5094

> Fax: 604 875 2226<Lesion May 3 2011.jpg>


Kate Sullivan, MD PhD
Professor of Pediatrics
ARC 1216 Immunology CHOP
3615 Civic Center Blvd.
Philadelphia, PA 19104
(p) 215-590-1697
(f) 267-426-0363