Discussions By Condition: I cannot get a diagnosis.

Chronic infection---need help NOW!!

Posted In: I cannot get a diagnosis. 5 Replies
  • Posted By: Anonymous
  • January 16, 2009
  • 10:44 PM

My husband is 34 years old and has been suffering with recurring infections (abcesses/cellulitis) in his leg, foot and hand for the last 7 months. He's been hospitalized 4 times (once for sepsis). He's been put on IV antibiotics (even vancomycin) as well as several varieties of oral antibiotics. Within 2-3 weeks of ending each round of antibiotics another abcess forms. Some have required major surgery to drain. He hasn't been able to work more than a day or two a month since July 2008. The bacteria they keep finding in the abcesses should easily be killed by his immune system (not MRSA). The infectious disease specialist said it's got to be an immune disorder but didn't know more than that. We have no diagnosis or prognosis. Please offer any ideas for prevention/treatment or type of physicians to see.

NOTE: he has been tested for HIV and was negative

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5 Replies:

  • Most recurrent infections of this type are due to either b-hemolytic strep or staff aureus and the most common predisposing factors are venous or lymphatic compromise, ie lymphedema. The secondary consideration, since the hand is involved as well, would be disruption of the skin barrier for a variety of reasons. While suggestions that the immune system is compromised would be plausible, there would tend to be supporting evidence in the way of other opportunistic infections such as fungal invasion that is normally suppressed by a healthy immune system. Recurrent cellulitis is actually distinct from cellulitis and requires more involved follow-up. A little medical history would also be valuable, ie any pre-existing illnesses or disease, etc. It would also be beneficial to know what type of lab studies have been performed to date and if you can post the results, it would be helpful in providing greater direction. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • January 17, 2009
    • 00:42 AM
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  • Are both legs and arms involved?
    Felsen 510 Replies
    • January 17, 2009
    • 01:53 AM
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  • Have they done at least a serum protein electrophoresis?
    richard wayne2b 1232 Replies
    • January 17, 2009
    • 01:15 PM
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  • Diabetes mellitus
    Anonymous 42789 Replies
    • January 17, 2009
    • 01:29 PM
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  • He has a history of psoriasis which has been treated in the past with immunosuppressant drugs (Raptiva/Enbrel). He stopped taking all medication at the first sign of infection back in July. The doctors we've seen have been chalking these infections up to the psoriasis medication but the infections continue even after 7 months without them.He noticed another abcess today and is on his way to his GP to have it drained AGAIN.The following bacteria have been found in wounds and/or blood since July:Enterococcus faecalisBacteroidesPrevotella melaninogenicaEscherichia coli (several times)Klebsiella pneumoniae (several times)Citrobacter freundii (several times and was found present in the current leg infection)He had been taking Raptiva for 5 years and was doing great until his body reacted. 18 months ago he reacted violently, his psoriasis flared worse than ever before and had uncontrolable diahrea. He had a colonoscopy (suspected Chrones) but no evidence was found. The Raptiva treatment was stopped and within a month his health was better and has not experienced symptoms of Chrones since. However, because this is in his file the doctors think the gram negative bacteria is because of the Chrones or a microscopic fistula in his intestine (never found).He began Enbrel treatment in February in an effort to control the psoriasis...again. But, like I said earlier as soon as there was a sign of infection he stopped the medication and has not taken a dose since July.I cannot beleive that these infections are a result of psoriasis treatment or a suspected case of Chrones when the infections are in his limbs not his stomach or buttocks.The infections are primarily in the right calf but he has had two abcesses in his left foot as well as his left hand.AGAIN...any help you can provide would be greatly appreciated. I am concerned for his emotional health as well as physical. His spirits are really low.I don't know if they've done a serum protein electrophoresis test. I have some of the records but don't know what I'm looking for.
    Anonymous 42789 Replies
    • January 17, 2009
    • 05:35 PM
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