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

Tue May 5 18:04:44 EDT 2015

We are also treating a Helicobacter (H. cinaedi) lower extremity soft
tissue infection in a patient with Bruton's.

He had 2 recurrences after being treated with meropenem and levofloxacin
for 6 weeks. He is currently improving on doxycycline, rifampin, and
amoxicillin. I think he likely needs a very prolonged course (6 months to a
year).

What duration have others had success with? Alternatively, what duration
have others had treatment failures with?

I like the idea of hyperbarics, especially for our patient since he has a
left lower extremity neuromyelitis, muscle atrophy and also had 2
debridements and a skin graft over the last 2 years. (likely poor perfusion
to that area)

Thanks!

On Sat, May 2, 2015 at 5:21 AM, Edgar, David <
david.edgar at belfasttrust.hscni.net> wrote:

>  Hi Klaus
> Is this now a chronic wound?
> We have had very dramatic success with hyperbaric oxygen in similar aged
> XLA patient with a chronic lower leg wound. This may be worth considering?
> Best Regards
> David
> Steele CL, Cridge C, Edgar JDM. A novel treatment in X Linked
> agammaglobulinaemia - Hyperbaric Oxygen Therapy in refractory chronic
> wounds. Journal of Clinical Immunology 2014; doi 10.1007/s10875-014-0078-4
> ------------------ via Blackberry
>
>  *From*: Prof. Dr. Klaus Warnatz [mailto:
> klaus.warnatz at uniklinik-freiburg.de]
> *Sent*: Friday, May 01, 2015 09:39 PM
> *To*: CIS-PIDD <cis-pidd at lyris.dundee.net>
> *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.
>
>
>  *Pere Soler Palacín, MD, PhD.* Pediatric Infectious Diseases and
> Immunodeficiencies Unit. Hospital Universitari Vall d'Hebron     Assistant
> Professor. Universitat Autònoma de Barcelona
> (UAB)
> Pg. de la Vall d'Hebron, 119-129
> 08035 Barcelona. Spain.
> Tel. 0034934893140 /  Fax 0034934893039
> psoler at vhebron.net  /  34660psp at comb.cat Web: www.upiip.com ORCIDID:
> http://orcid.org/0000-0002-0346-5570 Scopus Author ID:
> http://www.scopus.com/authid/detail.url?authorId=55923378300 ResearchGate:
> http://www.researchgate.net/profile/Pere_Soler-Palacin LinkedIn:
> http://es.linkedin.com/pub/pere-soler-palac%C3%ADn/73/918/b16
>
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-- 
Jasmeen S. Dara, MD MSc
Fellow in Allergy & Immunology
Albert Einstein College of Medicine
Children's Hospital at Montefiore

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