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

[Santhosh Kumar]

No recent immunosuppressive therapy or eating under cooked meat.

On Mar 13, 2013, at 5:07 PM, "Prescott Atkinson, M.D." <PAtkinson at peds.uab.edu> wrote:


> 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]

> 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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