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

[Santhosh Kumar/FS/VCU]

Previous hx of asthma which is not active currently.


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



From:   Sabiha Anis <sabiha_anis at hotmail.com>
To:     "CIS-PIDD" <cis-pidd at lists.clinimmsoc.org>
Date:   03/18/2013 01:17 AM
Subject:        RE: [cis-pidd] Eosinophilic cellulitis in XLA



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 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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