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

[Jane Peake]

The lesion looks clean and not infected. I work closely with a surgical colleague, when we have these sorts of problems, who also does a lot of burns work. We have had success treating lesions like this with Acticoat. I showed your photo to him and he suggested that it looks like it could be excised with primary closure and negative pressure dressing to allow to heal and to stop faecal soiling.
Cheers
Jane

Dr Jane Peake
Paediatric Immunologist and Allergist
Senior Lecturer
University of Queensland
level 3 Foundation Building
Royal Children's Hospital
Herston Rd, Herston QLD 4029
AUSTRALIA
Tel (61 7) 33655333 or 36365059
Fax (61 7) 33655455



-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Turvey, Stuart
Sent: Tuesday, 10 May 2011 2:53 AM
To: pagid at list.clinimmsoc.org
Subject: [CIS-PAGID] Recalcitrant buttock ulcer in a 2yo with X-linked CGD

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