[CIS PIDD] [cis-pidd] Eosinophilic cellulitis in XLA

[Rosenzweig, Sergio (NIH/NIAID) [E]]

If he had a recent cholecystectomy, I would consider campylobacter-like microorganisms (fexispira rappini/ helicobacter bills). Not the typical lower limb location, but his onset was pretty acute post surgery.
Sergio

Sergio D. Rosenzweig, MD, PhD
Director, Primary Immunodeficiency Clinic (PID-C)
LHD, NIAID, NIH
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Phone 301 451 8971
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From: "<Prescott Atkinson>", "M.D." <PAtkinson at peds.uab.edu<mailto:PAtkinson at peds.uab.edu>>
Reply-To: CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>>
Date: Wednesday, March 13, 2013 5:07 PM
To: CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>>
Subject: RE: [cis-pidd] Eosinophilic cellulitis in XLA


Any recent steroid/other immunosuppressive therapy?  We had an XLA patient about 20 yrs ago who developed Strongyloides hyperinfection when he was treated with steroids - he was being managed by pulmonary at the time and was thought to have variant CF....

Prescott



T. Prescott Atkinson, MD PhD, Professor and Director

Division of Pediatric Allergy, Asthma & Immunology

University of Alabama at Birmingham

Tel: 205-939-9072

Fax: 205-975-7080

________________________________
From: Santhosh Kumar/FS/VCU [skumar at vcu.edu<mailto:skumar at vcu.edu>]
Sent: Wednesday, March 13, 2013 2:54 PM
To: CIS-PIDD
Subject: [cis-pidd] Eosinophilic cellulitis in XLA

I saw an interesting consult today and was wondering if anyone had any thoughts on the case.

62 y/o Male with a diagnosis on Agammaglobulinemia on IVIG replacement. His trough levels have been pretty good >750mg/dl. He has had no infections for almost 20 years of his life but recently after an unsuccessful cholecystectomy (Jan 2013) developed abdominal wall erythema and induration. He has no complaints related to the erythema on his abdomen. He has a hx of Hep-c, cirrhosis of the liver, hepato-renal syndrome on dialysis (started 4wks ago). He was admitted once in the past for IV antibiotics as it was thought that this was abdominal cellulitis which did not improve the erythema. He is back again with slight worsening of the erythema and is currently being treated with Daptomycin. He has been on it for 2-3days with no significant improvement in his erythema.

His physical exam demonstrates no tenderness, large erythema over the anterior abdominal wall, b/l pitting pedal edema, ascites but otherwise normal. His eosinophil counts was normal in January but have recently increased to 2500. His most recent CBC shows -
Group   Detail  Date    Value w/Units   Flags   Normal Range    Comment Ind
HEMATOLOGY      WBC     03/13/13 03:00:23       11.4 10e9/L     H       3.7-9.7
HEMATOLOGY      RBC     03/13/13 03:00:23       2.74 10e12/L    L       4.54-5.78
HEMATOLOGY      Hemoglobin      03/13/13 03:00:23       9.6 g/dL        L       13.3-17.2
HEMATOLOGY      HCT     03/13/13 03:00:23       29.5 %  L       38.9-50.9
HEMATOLOGY      MCV     03/13/13 03:00:23       107.5 fL        H       81.2-94.0
HEMATOLOGY      MCH     03/13/13 03:00:23       35.1 pg         H       27.1-32.5
HEMATOLOGY      MCHC    03/13/13 03:00:23       32.7 g/dL               32.5-36.7
HEMATOLOGY      CHCM    03/13/13 03:00:23       32.2 g/dL       L       32.6-37.7
HEMATOLOGY      RDW     03/13/13 03:00:23       17.8 %  H       11.5-14.1
HEMATOLOGY      HDW     03/13/13 03:00:23       2.53 g/dL               2.38-3.15
HEMATOLOGY      PLT     03/13/13 03:00:23       UnableToReport          179-373         Y
HEMATOLOGY      MPV     03/13/13 03:00:23       UnableToReport          6.1-8.9         Y
HEMATOLOGY      % Neu   03/13/13 03:00:23       62.9 %          42.9-78.4
HEMATOLOGY      % Lym   03/13/13 03:00:23       7.4 %   L       14.1-45.8
HEMATOLOGY      % Mono  03/13/13 03:00:23       9.3 %   H       3.3-9.2
HEMATOLOGY      % Eos   03/13/13 03:00:23       19.9 %  H       0.3-6.2
HEMATOLOGY      % Baso  03/13/13 03:00:23       0.4 %           0.3-1.3
HEMATOLOGY      NEU     03/13/13 03:00:23       7.1 10e9/L      H       2.0-6.7
HEMATOLOGY      LYM     03/13/13 03:00:23       0.9 10e9/L      L       1.1-3.3
HEMATOLOGY      MONO    03/13/13 03:00:23       1.1 10e9/L      H       0.2-0.7
HEMATOLOGY      EOS     03/13/13 03:00:23       2.3 10e9/L      H       0.0-0.4
HEMATOLOGY      BASO    03/13/13 03:00:23       0.0 10e9/L              0.0-0.1
HEMATOLOGY      Morph/Comment   03/13/13 03:00:23       See Comment                     Y



Blood culture so far negative and the patient looks great. Can anyone comment if this could be eosinophilic cellulitis.

Thank you,

Santhosh Kumar, MD
Assistant Professor,
Allergy & Immunology
MCV/VCU
Ph:804-628-1605
Fax-804-828-1751

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