Multiple Skin Abscesses Research Articles

Multiple skin abscesses due to Nocardia neocaledoniensis: a case report and literature review

N. neocaledoniensis is a very rare infectious pathogen that causes human disease, particularly in immunocompromised individuals. In this case report, we describe the successful diagnosis of N. neocaledoniensis in a patient confirmed by mNGS and the treatment of multiple skin abscesses due to N. neocaledoniensis infection. mNGS is an important diagnostic method complementary to routine bacterial culture and identification methods, especially for rare, novel, co-infected pathogens, and pathogens that are difficult to culture. This report may provide a reference for the clinical treatment and diagnosis of N. neocaledoniensis infection in humans.

A case series of melioidosis: An underdiagnosed entity in Kerala

Abstract Melioidosis is an emerging infection in India and is caused by a Gram-negative oxidase-positive bacilli, Burkholderia pseudomallei which is present in soil and surface water in the endemic region. Clinical manifestations are protean varying from asymptomatic infection, multiple skin abscesses, chronic pneumonia mimicking tuberculosis, and fulminant septic shock with abscesses in multiple internal organs. Isolation of bacilli from aspirated fluids remains the gold standard of diagnosis. Lack of microbiological services in many parts of the state, protean nature of clinical manifestations, lack of awareness among clinicians, and misidentification of the organism as Pseudomonas spp leads to delay in diagnosis and treatment. We have, retrospectively, analyzed 14 cases with culture-proven melioidosis diagnosed during 10 years. Case records of culture-positive patients were retrospectively analyzed for demographic data, clinical characteristics, management, complications, and clinical outcomes. Out of these, 13 cases were male. The most common age group affected was 50–59 years. The major occupation affected was manual laborer. Nonbacteremic melioidosis accounted for 12 cases. Concerning clinical presentations, intra-abdominal abscesses mainly in the liver and spleen accounted for seven cases. All the isolates were susceptible to ceftazidime, meropenem, and doxycycline, whereas 12 isolates were susceptible to chloramphenicol, 11 isolates were susceptible to trimethoprim–sulfamethoxazole combination, and 10 cases were susceptible to amoxicillin–clavulanic acid and ciprofloxacin. Ten cases recovered with ceftazidime administration along with surgical drainage of abscess and three cases recovered with meropenem administration and surgical drainage. One patient expired and was on piperacillin–tazobactam. Melioidosis is a disease of public health importance and early clinical and laboratory diagnosis is crucial in the effective management of melioidosis.

An unusual case of multiple skin abscesses caused by methicillin-resistant <i>Staphylococcus aureus </i>in a 6-year-old boy

This report is a rare case of a 6-year-old child presenting with multiple skin abscesses resulting from a methicillin-resistant Staphylococcus aureus (MRSA) infection post blunt trauma to the pelvic region. Staphylococcus aureus poses challenges due to its antibiotic resistance. The child’s condition, marked by sepsis and extensive abscesses, prompted a multidisciplinary approach involving antibiotic therapy and surgical interventions. The MRSA strain exhibited resistance to various antibiotics, emphasizing the importance of individualized treatment as per the case. The case underlines the complexities of managing multi-site MRSA infections and emphasizes the significance of accurate diagnosis, appropriate antibiotic selection, and surgical intervention for successful outcomes.

Early Onset Portal Hypertension Due to Silent Extensive Portal Vein Thrombosis Following Umbilical Vein Catheterization

Background: Umbilical vein catheterization is a routine procedure in neonatal intensive care units. This invasive procedure, though easy and useful, can result in disastrous complications. Clinical Description: A 28 day old baby boy presented with umbilical sepsis along with multiple skin abscesses. He had a history of double volume exchange transfusion for Glucose 6 Phosphate deficiency induced hyperbilirubinemia, during the postnatal period. Ultrasound whole abdomen done to look for intra-abdominal abscesses revealed extensive portal vein thrombosis including the main portal vein and its branches with cavernoma formation. Upper gastrointestinal endoscopy revealed Grade II esophageal varices suggestive of the development of portal hypertension. Management and Outcome: Baby was started on subcutaneous enoxaparin which continued for 3 months. Follow up ultrasound showed complete obliteration of portal vein, replaced by cavernomas with development of grade II esophageal varices seen on upper gastrointestinal endoscopy. Conclusion: This case highlights how umbilical vein catheterization in the neonatal period can lead to catastrophic complications such as obliteration of the entire main portal vein and its branches, formation of portal cavernoma, portal hypertension, and esophageal varices, all of which can develop silently, at a very early age.

Paraganglioma

Introduction: Paragangliomas are rare neuroendocrine tumors arising from extra-adrenal medullary neural crest derivatives. The terms pheochromocytoma and paraganglioma are often used interchangeably because morphologically and functionally these entities are almost the same. However, paragangliomas that arise in the adrenal medulla are called pheochromocytomas and those outside the adrenal gland are called paragangliomas. Paragangliomas are often discovered incidentally during imaging studies performed for other reasons. We report a case of a patient who had incidental finding of retroperitoneal paraganglioma on imaging done for evaluation of thigh and gluteal cellulitis. Clinical Case: A 24-year-old female presented with chief complaints of episodic headaches, multiple skin abscesses, fever and malaise. She has a history of Type 1DM and had been non-compliant on insulin. Vitals on presentation was significant for tachycardia with heart rate of 124, blood pressure of 119/81, respiratory rate of 16. Initial labs were consistent with DKA. CT abdomen and pelvis done for further evaluation of gluteal and thigh abscess showed incidental finding of a 3.4 cm retroperitoneal/para-aortic well-circumscribed rim-enhancing mass with central hypoenhancing component, suspicious for neoplasm such as paraganglioma. Biochemical testing was performed. 24-hour urine catecholamine levels obtained showed elevated urine norepinephrine level of 1008μg/day (reference range 15-100μg/day), urine dopamine 410μg/day (reference range 65- 400μg/day), urine epinephrine less than 2μg/day (reference range 0-20μg/day). Total urine catecholamines was elevated 1008μg/day (reference range 15-100μg/day). These results confirmed diagnosis of paraganglioma. Treatment options were discussed with the patient including surgery for removal of paraganglioma which she has currently declined. Conclusion: Diagnosis of a paraganglioma can usually be made using biochemical and radiographic testing. All patients with paraganglioma should be tested for hypersecretion of catecholamines in a 24-hour urine or serum collection, even if they do not present with a clinical picture of catecholamine hypersecretion. Importantly these extra-adrenal tumors do not have the enzymatic capacity to form epinephrine from norepinephrine as was exemplified by our case. For catecholamine-secreting tumors, biochemical diagnosis should be followed by radiological evaluation (typically either CT or MRI of the abdomen and pelvis) to locate the tumor. Treatment options are dependent on location of tumor, size, presence of symptoms and if there is metastatic disease present.

THE INDOLENT SANDSTORM: A RARE CASE OF MULTIFOCAL DISSEMINATED COCCIDIOIDOMYCOSIS

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Coccidioidomycosis is a highly variable disease endemic in the southwest with 60% of infected individuals remaining asymptomatic or suffer mild respiratory illness. Less than 1% result in life-threatening dissemination with immunocompromised hosts being most at risk. We present a rare case of multifocal disseminated coccidioidomycosis (DC) in an immunocompetent young male from a non-endemic region. CASE PRESENTATION: A 35 year old previously healthy African American male presented with persistent multiple skin abscesses on his face and neck with purulent drainage, neck pain and right foot pain for 2 months accompanied by a 20 lb weight loss. Upon examination he was febrile with a temperature of 102.8F and tachycardic. There was localized crusting and purulent drainage at the right mandibular body and anterior neck. Large, tender fluctuant masses were noted throughout the anterior neck coupled with cervical lymphadenopathy. A neck Computed Tomography (CT) scan revealed a large retropharyngeal abscess extending from C2-T1 vertebrae, osseous erosion into cervical spine C2-C6 with anterior cervical and ventral epidural abscesses, and multiple bilateral neck abscesses. Patient underwent a C3-C6 decompressive laminectomy and bilateral neck exploration with washout of abscesses. Subsequent imaging identified bony destruction of several ribs and abscessed tenosynovitis of the right ankle. Fungal culture from neck and ankle abscess grew Coccidioides immitis. An acquired immunodeficiency syndrome and immunoglobulin workup was negative. Liposomal amphotericin B, itraconazole, and interferon gamma 1b (INF-y) were used as treatment for multifocal DC. A 7 week hospital course was complicated by recurrent and metastatic C. immitis infections involving widespread multifocal areas of bony destruction and isolated cutaneous lesions. Despite aggressive treatment our patient passed from overwhelming infection. DISCUSSION: Our case illustrates the unexpected presentation of DC - an immunocompetent patient from a non-endemic region. Male gender, African American or Filipino race, and those living in endemic areas have a much higher incidence of dissemination. The skin is the most common extrapulmonary site of endemic mycosis with systemic symptoms being largely absent as seen in our patient. Rare genetic defects in the STAT3 family of proteins coding for INF-y have been implicated in this process. Combination therapy with antifungals and IFN-y has been reported with success in a small case series. A genetic testing panel yielded negative results. CONCLUSIONS: Our case represents an exceedingly rare presentation of an uncommon illness in an unlikely clinical setting - and stresses the importance of a robust differential diagnosis. Reference #1: Odio CD, Marciano BE, Galgiani JN, Holland SM. Risk Factors for Disseminated Coccidioidomycosis, United States. Emerg Infect Dis. 2017;23(2):308–311. Reference #2: Stockamp NW, Thompson GR. Coccidioidomycosis. Infect Dis Clin North Am. 2016 Mar;30(1):229-46. Reference #3: Hung CY. Castro-Lopez N. Cole GT. Card9- and MyD88-Mediated Gamma Interferon and Nitric Oxide Production is Essential for Resistance to Subcutaneous Coccidioides posadasii Infection. Infect Immun. 2016 Mar 24;84(4):1166-75. DISCLOSURES: No relevant relationships by Amy Goodrich-Harris, source=Web Response No relevant relationships by Paul Marik, source=Web Response No relevant relationships by Mit Patel, source=Web Response No relevant relationships by Timothy Walls, source=Web Response

Disseminated actinomycosis in an immunocompetent patient: a case report

This case report describes a 58-year-old patient who visited the hospital after an 8-month disease period characterized by multiple skin and soft tissue abscesses associated with an approximately 20-kg weight loss, severe hypoalbuminemia, moderate anemia and polyserositis. Several imaging tests revealed abscesses on the left thigh muscle. Additionally, abdomen, pelvis and thorax ultrasounds showed bilateral interstitial nephropathy, ascites and bilateral pleural effusion. The histopathological examination confirmed the diagnosis of actinomycosis. Given the systemic manifestations and diffuse distribution of the abscesses, the case was clinically consistent with disseminated actinomycosis. Therefore, the patient received IV antibiotic treatment with penicillin G sodium for 4 weeks and then with amoxicillin p.o. The patient evolved favorably and exhibited abscess remission.

PS1161 EFFICACY AND SAFETY OF IBRUTINIB IN RELAPSED/REFRACTORY CHRONIC LYMPHOCYTIC LEUKEMIA PATIENTS PREVIOUSLY TREATED WITH VENETOCLAX IN THE MURANO STUDY

Background:The BCL2 inhibitor venetoclax (Ven) and the Bruton's tyrosine kinase inhibitor ibrutinib (IBR) have complementary mechanisms of action in chronic lymphocytic leukemia (CLL). As data with targeted agents become available for earlier therapy lines, it is important to understand how to sequence these new regimens best in CLL.Aims:To present a post‐hoc series, obtained after follow‐up from the randomized, phase 3 MURANO study (NCT02005471), of patients (pts) with relapsed/refractory (R/R) CLL who received IBR following fixed‐duration treatment with Ven+rituximab (VenR).Methods:389 pts with R/R CLL were enrolled in MURANO and received 6 cycles of bendamustine (B)+R or 6 cycles of VenR followed by Ven monotherapy once daily for up to 2 years. Primary endpoint was investigator‐assessed progression‐free survival (PFS). This case series reports outcomes for pts treated with VenR in MURANO (IBR‐naïve at study inclusion) who developed progressive disease (PD) and were treated subsequently with IBR.Results:PFS was significantly longer in pts who received fixed‐duration VenR compared with those treated with BR (hazard ratio for overall MURANO population: 0.16 [95% confidence interval: 0.12–0.23]; p < 0.001). As of the May 8, 2018 data cut‐off (median follow‐up: 36 months), 28% of pts (55/194) in the VenR arm had experienced a PFS event (i.e. progression or death, whichever occurred first). Eight pts who had received VenR and experienced a PD event were treated subsequently with IBR (median treatment duration at last follow‐up: 13.5 months [range 3–42]). For these pts, the median number of therapy lines preceding VenR treatment was 1 (range: 1–4). Before VenR treatment, 7 pts had received fludarabine+cyclophosphamide+R (FCR), of whom 3 had achieved complete response (CR), 3 partial response (PR), and 1 had stable disease (SD) on FCR. Two FCR‐treated pts (1 with PR and 1 with CR on VenR) were considered refractory to FCR prior to VenR treatment.Before VenR treatment, 3 pts had a chromosome 17p deletion, 5 had mutated TP53, 1 had chromosome 11q deletion, 4 had unmutated IGVH, 6 had lymph nodes (LN) >10 cm and 2 had LN ≥5–<10 cm. Baseline lymphocyte counts ranged from 0.14 to 388.6 × 109/L, platelets from 59 to 228 × 109/L, and neutrophils from 0.38 to 4.37 × 109/L. Best response to VenR included CR in 3 and PR in 5 pts; 5 pts achieved minimal residual disease negativity at some point during VenR treatment. Chromosomal status and blood cell counts before IBR treatment were unavailable. All 8 pts achieved a response to IBR (7 PR, 1 very good PR). At last follow‐up, 6 pts were still on treatment (of whom 1 was due to stop due to PD after 40 months), 2 had stopped due to PD after approx. 3.5 and 7 months; no pts had died.Four pts had IBR dose modification or interruption due to neutropenia (n = 2), clarithromycin treatment (n = 1), or cutaneous nevus biopsy (n = 1). Multiple skin abscesses were observed in 1 pt. Two pts had arthralgia, 1 case of which had nearly resolved on follow‐up, 1 pt had atrial fibrillation, 1 had pneumonia (without hospital admission), and no instances of major bleeding were reported.Summary/Conclusion:IBR demonstrated an acceptable tolerability profile with no new safety signals as well as good clinical activity in this series of R/R CLL pts who received IBR following VenR treatment in MURANO. IBR treatment, therefore, seems an acceptable option for pts with CLL who relapse following VenR. More data will be gathered from the MURANO study for pts treated with VenR who progress and subsequently receive treatment with IBR.image

Panton-Valentine Leukocidin (PVL) Skin Abscesses in Children and Adolescents Diagnostic and Treatment - A Case Report

Panton–Valentine leukocidin is a cytotoxin, which is associated with an increased virulence of isolates of Staphylococcus aurous. It can cause necrotic dermal lesions or recurrent skin abscesses and in rare cases necrotic haemorrhagic pneumonia. In our case a 15-year-old immunocompetent male was seen in the emergency department complaining of a painful tibial swelling. He had been travelling to South East Asia a year ago and had been suffering from multiple skin abscesses since then. Clinically, a tibial abscess was diagnosed and operatively excised the same day. The postoperative course of the patients was uneventful. In the microbiological analysis a methicillin-susceptible Staphylococcus aurous was isolated and the presence of lukF-lukS genes for Panton–Valentine leukocidin was determined. In order to avoid further spread of the cytotoxin the patient underwent an ambulant antibiotic eradication therapy with Cotrimoxazole 960mg twice daily for 5 days along with a decolonisation. An infection with Panton–Valentine leukocidin should be suspected diagnosed and treated in young immunocompetent patients with recurrent cutaneous abscesses or affected contacts.

Efficacy and Safety of Ibrutinib (IBR) after Venetoclax (VEN) Treatment in IBR-Naïve Patients with Relapsed/Refractory (R/R) Chronic Lymphocytic Leukemia (CLL): Follow-up of Patients from the MURANO Study

Efficacy and Safety of Ibrutinib (IBR) after Venetoclax (VEN) Treatment in IBR-Naïve Patients with Relapsed/Refractory (R/R) Chronic Lymphocytic Leukemia (CLL): Follow-up of Patients from the MURANO Study

Orthodontic management of delayed permanent tooth eruption and a case report of hyper-IgE syndrome

This article aims to look at the treatment and management of patients presenting with delayed tooth eruption of the permanent dentition. We describe the case of a 17-year-old girl who presented having been diagnosed with Hyper-IgE syndrome. The patient was positive for the STAT-3 gene and presented with a history of some classic Hyper-IgE features. There was a history of multiple skin abscesses and she was on long-term antibiotics. She presented in the mixed dentition with multiple retained deciduous teeth and a full complement of unerupted and fully formed permanent teeth. This article will describe features of this syndrome and discuss management strategies for patients presenting with delayed eruption. Clinical Relevance: This case study highlights the difficulties in managing patients who present with retained primary dentition at an older age. It also presents a rare case presentation of a patient with Hyper-IgE.

Multiple Skin and Brain Abscess Caused by Salmonella Typhi, First Reported Case in Bangladesh

Focal Brain and skin abscesses due to Salmonella are rarely reported. They tend to occur in patients who are immunosuppressed and in those with other predisposing factors like; sickle cell disease. We presented a case of a 28-year-old female of multiple skin and brain abscesses caused by Salmonella Typhi with no predisposing factor. After starting treatment according to culture and sensitivity report, she completely recovered without any residual disability.Bangladesh J Medicine Jul 2015; 26 (2) : 83-85

A Girl with Eczematous Lesions, Multiple Recurrent Skin Abscesses and Mucocutaneous Candidiasis

Pediatric DermatologyVolume 30, Issue 5 p. 621-622 A Girl with Eczematous Lesions, Multiple Recurrent Skin Abscesses and Mucocutaneous Candidiasis Gisela Hebe Petiti Martin M.D., Gisela Hebe Petiti Martin M.D. Department of Dermatology, Hospital 12 de Octubre, Madrid, SpainSearch for more papers by this authorMaría Villar Buil M.D., María Villar Buil M.D. Department of Dermatology, Hospital 12 de Octubre, Madrid, SpainSearch for more papers by this authorMar Burgués Calderón M.D., Mar Burgués Calderón M.D. Department of Dermatology, Hospital 12 de Octubre, Madrid, SpainSearch for more papers by this authorLuis M. Allende M.D., Luis M. Allende M.D. Department of Immunology, Hospital 12 de Octubre, Madrid, SpainSearch for more papers by this authorJavier Ortíz Frutos M.D., Javier Ortíz Frutos M.D. Department of Immunology, Hospital 12 de Octubre, Madrid, SpainSearch for more papers by this author Gisela Hebe Petiti Martin M.D., Gisela Hebe Petiti Martin M.D. Department of Dermatology, Hospital 12 de Octubre, Madrid, SpainSearch for more papers by this authorMaría Villar Buil M.D., María Villar Buil M.D. Department of Dermatology, Hospital 12 de Octubre, Madrid, SpainSearch for more papers by this authorMar Burgués Calderón M.D., Mar Burgués Calderón M.D. Department of Dermatology, Hospital 12 de Octubre, Madrid, SpainSearch for more papers by this authorLuis M. Allende M.D., Luis M. Allende M.D. Department of Immunology, Hospital 12 de Octubre, Madrid, SpainSearch for more papers by this authorJavier Ortíz Frutos M.D., Javier Ortíz Frutos M.D. Department of Immunology, Hospital 12 de Octubre, Madrid, SpainSearch for more papers by this author First published: 10 September 2013 https://doi.org/10.1111/j.1525-1470.2012.01793.x Address correspondence to Gisela Hebe Petiti Martin, M.D., Avda de Cordoba S/N, 28041 Madrid, Spain, or e-mail: [email protected]. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume30, Issue5September/October 2013Pages 621-622 RelatedInformation

Serum amyloid A renal amyloidosis in a chronic subcutaneous ("skin popping") heroin user.

Systemic AA amyloidosis is a long-term complication of several chronic inflammatory disorders. Organ damage results from the extracellular deposition of proteolytic fragments of the acute-phase reactant serum amyloid A (SAA) as amyloid fibrils. Drug users that inject drug by a subcutaneous route ("skin popping") have a higher chance of developing secondary amyloidosis. The kidneys, liver, and spleen are the main target organs of AA amyloid deposits. More than 90% of patients with renal amyloidosis will present with proteinuria, nephrotic syndrome, or renal function. A 37 year-old female presented to the hospital with a one-week history of pain and redness in her right axilla. Her relevant medical history included multiple skin abscesses secondary to "skin popping", heroin abuse for 18 years, and hepatitis C. The physical examination revealed "skin popping" lesions, bilateral costovertebral angle tenderness, and bilateral knee swelling. The laboratory workup was significant for renal insufficiency with a serum creatinine of 5 mg/dL and 14.8 grams of urine protein per 1 gram of urine creatinine. The renal biopsy findings were consistent with a diagnosis of renal amyloidosis due to serum amyloid A deposition and acute tubulointerstitial nephritis. AA renal amyloidosis among heroin addicts seems to be associated with chronic suppurative skin infection secondary to "skin popping". It is postulated that the chronic immunologic stimulation by one or more exogenous antigens or multiple acute inflammatory episodes is an important factor in the pathogenesis of amyloidosis in these patients. Therefore, AA renal amyloidosis should always be considered in chronic heroin users presenting with proteinuria and renal impairment.

Neonatal sepsis and multiple skin abscess in a newborn with Down’s syndrome: A case report

Neonatal sepsis is a leading cause of neonatal mortality. Congenital heart disease accounts for additional risk of sepsis in neonates. Here we report a case of Down's syndrome with late onset neonatal sepsis associated with multiple superficial skin abscesses simulating staphylococcal infection. The baby was empirically treated with vancomycin. Subsequently, multidrug resistant Klebsiella pneumoniae was detected from both pus and blood culture. Change to appropriate antibiotic resulted in clinical recovery. Although sepsis is one of the major ailments in neonates, atypical presentations of neonatal sepsis in Down's syndrome patients are underreported. Here we highlight the atypical presentation of Klebsiella sepsis and the importance of early antibiogram in such cases.

Pulmonary cavitation and skin lesions mimicking tuberculosis in a HIV negative patient caused by Sporothrix brasiliensis

A 32-year-old HIV negative male presented with multiple pulmonary cavitation and skin abscesses up to 15cm in diameter mimicking tuberculosis. Sporothrix brasiliensis was isolated and patient responded well to amphotericin B followed by itraconazole, except the skin lesions that had to be surgical drained to obtain cure.

Complicated Community-Acquired Staphylococcus Endocarditis and Multiple Lung Abscesses: Case Report and Review of Literature

Background. Isolated tricuspid valve endocarditis in the absence of risk factors in the community setting is very rare and can be easily missed in patients with hitherto normal valves. Case Presentation. We present a case of a 49 year old gentleman who presented with generalized body aches, fever, and jaundice and was initial diagnosed as hepatitis. He subsequently developed recurrent episodes of panic attacks and shortness of breath and later multiple skin abscesses. Further investigations excluded pulmonary embolism but revealed multiple abscesses in the body including the lungs. Blood cultures and culture from abscesses grew S. aureus. An initial transthoracic echocardiogram was normal. A transesophageal echocardiogram subsequently confirmed endocarditis on a normal natural tricuspid valve and multiple lung abscesses. He was successfully treated with appropriate antibiotics. Conclusion. We discuss the pathogenesis of this patient's presentation highlight the need for assessment and proper evaluation of patients with unexplained bacteremia.

Tricuspid endocarditis in hyper-IgE syndrome

Hyper-IgE syndrome is a congenitally acquired primary immune deficiency condition. We report a case of possible hyper-IgE syndrome who presented with multiple cold skin abscesses and chest infection due to Staphylococcus aureus and hyper-IgE findings. Patient also had tricuspid valve acute bacterial endocarditis with purulent pericarditis which is very rare. This case is presented to highlight that early diagnosis and treatment in such cases decreases the mortality and morbidity in phagocytic disorders.

A young man with hyperimmunoglobulin-E syndrome and IgA and IgG deficiencies

Hyperimmunoglobulin E syndrome (HIES) with recurrent infection is a rare primary immunodeficiency characterized by the clinical triad of recurrent staphylococcal abscesses, cyst-forming pneumonia and an elevated serum immunoglobulin (Ig)E level. We report an 18-year-old man with recurrent chest infections, skin infections and dermatitis. On examination, he had the characteristic facies of HIES: high arched palate, webbing between his thumb and index finger bilaterally, and extensive scarring from multiple staphylococcal skin abscesses. He had an elevated IgE level of 14 300 kU/L. IgA and IgG deficiencies were also identified, which are rare associations of this syndrome and complicated the patient's treatment. The coexistence of HIES, IgA and IgG deficiencies has, to our knowledge, not been reported previously in the literature.

Neonatal Mycotic Internal Iliac Aneurysm due to Methicillin-resistant Staphylococcus aureus (MRSA) Septicaemia Successfully Treated by Coil Embolisation

A 12-day-old term male neonate presented with septic arthritis, multiple skin and intrabdominal abscesses and a mycotic aneurysm of the right internal iliac artery. He was diagnosed as having methicillin resistant staphylococcus aureus (MRSA) septicaemia and deemed unsuitable for surgical treatment of the aneurysm. Coil embolisation of the internal iliac artery was performed, followed by a successful recovery and with no evidence of residual or recurrent infection. The authors describe a method of treating internal iliac mycotic aneurysms in high-risk patients by endovascular means, which we believe has not been attempted in this precise scenario before.