[CIS PIDD] [cis-pidd] Agammaglobulinemia and suspected Helicobacter canadensis like induced infection of the calf

Fri May 1 23:52:12 EDT 2015

Dear Prof. Warnatz,
Have you tried doxycycline and metronidazole combination therapy that has been reported to provide effective treatment for a case similar to the patient that you have described:
Recurrent Bacteremia and Multifocal Lower Limb Cellulitis Due to Helicobacter-Like Organisms in a Patient with X-Linked Hypogammaglobulinemia
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| Recurrent Bacteremia and Multifocal Lower Limb Celluliti...Recurrent Bacteremia and Multifocal Lower Limb Cellulitis Due to Helicobacter-Like Organisms in a Patient with X-Linked Hypogammaglobulinemia John Gerrard1... |
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  I hope this may be helpful.
Best regards,Soheil
Soheil Chegini, MD
Exton Allergy & Asthma Associates 656 W. Lincoln Hwy.Exton, PA 19341
Phone: (610) 269-3066Fax: (610) 269-8615

      From: Prof. Dr. Klaus Warnatz <klaus.warnatz at uniklinik-freiburg.de>
 To: CIS-PIDD <cis-pidd at lyris.dundee.net> 
 Sent: Friday, May 1, 2015 4:39 PM
 Subject: [cis-pidd] Agammaglobulinemia and suspected Helicobacter canadensis like induced infection of the calf

I would appreciate your input on  a 36 y/o patient with XLA who acquired a soft tissue infection of the right calf in 2004 after a visit to Corfu. The biopsy revealed a lymphocytic panniculitis no signs of T cell lymphoma. An initial therapeutic attempt with steroids was without effect so that Tacrolimus was started. Under this therapy he developed a sepsis and one blood culture revealed a Helicobacter Canadensis like bacterium. After different attempts of antibiotic treatment he clearly improved under imipinem/fosfomycin but several attempts to stop the therapy even after years failed and so again this January. In the MRI of the calf from 12/2014 there were increased signals in the tibia in the T2 weighted images but no contrast medium enhancement, so that the radiologists did not find evidence of an ongoing osteomyelitis, there was no affection of the neighboring muscles. PET scan did not reveal additional sites. Otherwise infections are well controlled under IGRT with serum trough levels of 12g/l IgG. Is there any way to improve diagnosis? All additional attempts to culture the pathogen failed in the past therefore there is very limited information on the resistance profile. Is there any alternative treatment regimen which more likely would allow the eradication of the pathogen? With best regards    klaus    Prof. Dr. med. Klaus Warnatz    MEDICAL CENTER – UNIVERSITY OF FREIBURG Center for Chronic Immunodeficiency – CCI Department of Rheumatology and Clinical Immunology    Breisacher Str. 117, 79106 Freiburg, Germany Tel. +49 761 270 77640 / FAX -71000 / Pager 12-7100 klaus.warnatz at uniklinik-freiburg.de    www.uniklinik-freiburg.de/cci    Von: Prof. Dr. Stephan Ehl [mailto:stephan.ehl at uniklinik-freiburg.de]
Gesendet: Donnerstag, 30. April 2015 12:18
An: CIS-PIDD
Cc: Oscar Segarra Canton
Betreff: Re: [cis-pidd] NEMO and BID    Capucine picard is currently collecting the international experience on this and should have the best overview. Best wishes, St. 
Beste Grüße

Prof. Dr. Stephan Ehl
Medizinischer Direktor

UNIVERSITÄTSKLINIKUM FREIBURG 
CCI - Center for Chronic Immunodeficiency

Breisacher Str. 117 - 2. OG, 79106 Freiburg i. Brsg., Germany
phone: +49(0)761.270-77300
Sekretariat +49(0)761.270-77550  fax +49(0)761.270-77600
e-mail: stephan.ehl at uniklinik-freiburg.de    Von:Pere Soler Palacin <psoler at vhebron.net>
Antworten an: CIS-PIDD <cis-pidd at lyris.dundee.net>
Datum: Donnerstag, 30. April 2015 11:55
An: CIS-PIDD <cis-pidd at lyris.dundee.net>
Cc: Oscar Segarra Canton <osegarra at vhebron.net>
Betreff: [cis-pidd] NEMO and BID    Dear all, I'd appreciate your inputs on a new case we have. He's a 15 yo boy who was followed by our gastroenterologists due to inflammatory bowel disease (diagnosis was made at 13 years of age due to arthritis and diarrhoea) that was unresponsive to steroids and azathioprine. Then, infliximab was started and PID screening was performed yielding a mutation in the X-linked NEMO gene both mother and sister are carriers of the mutation). My questions are: - Do you have any experience in NEMo deficiency patients presenting only with Crohn-like phenotype? - I'm worried about the risk of mycobacteriosis in a patient with NEMO-def receiving infliximab. Would you consider any other therapeutic option? - The patient is doing clinically well, should SCT be considered in this case?   Thanks in advance and best regards from Barcelona,   P.    ADDRESS:
Pere Soler Palacín, MD, PhD.
 ADDRESS:
Pediatric Infectious Diseases and Immunodeficiencies Unit. Hospital Universitari Vall d'Hebron    
 ADDRESS:
Assistant Professor. Universitat Autònoma de Barcelona (UAB)                                                      
Pg. de la Vall d'Hebron, 119-129
08035 Barcelona. Spain.
Tel. 0034934893140 /  Fax 0034934893039
 ADDRESS:

psoler at vhebron.net  /  34660psp at comb.cat
 ADDRESS:
Web: www.upiip.com
 ADDRESS:
ORCIDID:http://orcid.org/0000-0002-0346-5570
 ADDRESS:
Scopus Author ID:http://www.scopus.com/authid/detail.url?authorId=55923378300
 ADDRESS:
ResearchGate:http://www.researchgate.net/profile/Pere_Soler-Palacin
 ADDRESS:
LinkedIn:http://es.linkedin.com/pub/pere-soler-palac%C3%ADn/73/918/b16
 ADDRESS:

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