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

[Sabiha Anis]

Any H/O asthma?  Thinking in terms of churg strauss....
Sabiha


From: skumar at vcu.edu
Subject: Re: [cis-pidd] Eosinophilic cellulitis in XLA
Date: Sun, 17 Mar 2013 15:35:30 -0400
To: cis-pidd at lists.clinimmsoc.org

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 DirectorDivision of Pediatric Allergy, Asthma & ImmunologyUniversity of Alabama at BirminghamTel: 205-939-9072Fax: 205-975-7080From: 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 -   
GroupDetailDateValue w/UnitsFlagsNormal RangeComment IndHEMATOLOGYWBC03/13/13 03:00:2311.4 10e9/LH3.7-9.7HEMATOLOGYRBC03/13/13 03:00:232.74 10e12/LL4.54-5.78HEMATOLOGYHemoglobin03/13/13 03:00:239.6 g/dLL13.3-17.2HEMATOLOGYHCT03/13/13 03:00:2329.5 %L38.9-50.9HEMATOLOGYMCV03/13/13 03:00:23107.5 fLH81.2-94.0HEMATOLOGYMCH03/13/13 03:00:2335.1 pgH27.1-32.5HEMATOLOGYMCHC03/13/13 03:00:2332.7 g/dL32.5-36.7HEMATOLOGYCHCM03/13/13 03:00:2332.2 g/dLL32.6-37.7HEMATOLOGYRDW03/13/13 03:00:2317.8 %H11.5-14.1HEMATOLOGYHDW03/13/13 03:00:232.53 g/dL2.38-3.15HEMATOLOGYPLT03/13/13 03:00:23UnableToReport179-373YHEMATOLOGYMPV03/13/13 03:00:23UnableToReport6.1-8.9YHEMATOLOGY% Neu03/13/13 03:00:2362.9 %42.9-78.4HEMATOLOGY% Lym03/13/13 03:00:237.4 %L14.1-45.8HEMATOLOGY% Mono03/13/13 03:00:239.3 %H3.3-9.2HEMATOLOGY% Eos03/13/13 03:00:2319.9 %H0.3-6.2HEMATOLOGY% Baso03/13/13 03:00:230.4 %0.3-1.3HEMATOLOGYNEU03/13/13 03:00:237.1 10e9/LH2.0-6.7HEMATOLOGYLYM03/13/13 03:00:230.9 10e9/LL1.1-3.3HEMATOLOGYMONO03/13/13 03:00:231.1 10e9/LH0.2-0.7HEMATOLOGYEOS03/13/13 03:00:232.3 10e9/LH0.0-0.4HEMATOLOGYBASO03/13/13 03:00:230.0 10e9/L0.0-0.1HEMATOLOGYMorph/Comment03/13/13 03:00:23See CommentY


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 
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