A 24-year-old male with a history of multiple skin lesions for five years who, during the last two years, presented pyodermitis, sarna corporis, esophageal candidiasis and five cases of skin abscesses extensor dorsum in one hand.
She presented pain and increased volume in the left glue. She was diagnosed with clindamycin and cefazolin.
On the seventh day of hospitalization, the patient presented distal necrosis of the pulp of the fourth finger of the right hand, which was left to natural evolution due to being out of surgical reach.
After 12 days of antibiotic treatment the scheme was changed due to poor clinical response, starting metronidazole, ceftriaxone and vancomycin.
Laboratory, immunological and infectious tests were performed in search of an underlying pathology, shown in Table 1 (A), of which the results of rheumatoid factor, p-ANCA-ANCA-3, anticardiolipin HBV antigens, anticardiolipin
Left-sided ultrasonography was also performed, which showed inflammatory and non-subcutaneous cellular tissue.
Contrast-enhanced computed tomography (CT) of the chest suggested basal fibrosis with pleural thickening and peripheral nodular image in both hemithorax.
Radiographs of the hands, radiographs of the shoulder girdle, radiographs of the dorsolumbar spine, radiographs of the elbows, abdominal ultrasound, CT scan of the abdomen and echocardiogram showed no pathological findings.
A skin biopsy of the medial area of the right arm reported as chronic granulation dermatitis with dystrophic calcification, with no signs of vasculitis.
After completing the antibiotic treatment she was discharged with diagnostic suspicion of hyper IgE syndrome and cryoglobulinemia.
1.
One month after discharge, the patient presented with a new 5-day history of pain in the left glue, local heat and suppuration.
Manual and passive drainage with penrose was performed.
She was hospitalized for abscess in the left glue and antibiotic treatment with ceftriaxone and clindamycin was initiated.
Tests are shown in Table 1 (B) where again raised levels of IgE, a first sample with values of 4,170 IU/ml and a second sample the day after 4,210 IU/ml.
The Grimbacher9 scale was applied to record the value of IgE, systemic candidiasis, severe infections, recurrent skin infections, presence of high palate, primary teeth retained nose, clinically significant joint distance DS.
After 21 days of antibiotic treatment she was discharged, using antibiotic prophylaxis with trimethoprim/sametoxazol.
In a 1-year follow-up, the patient presented a favorable evolution without new cutaneous, systemic infections or cutaneous manifestations.
