An 8-year-old boy presented with eczematous skin lesions, recurrent otitis media and unexplained pyrexias. X-linked agammaglobulinaemia was diagnosed and treatment commenced with intravenous immunoglobulin replacement therapy. X-linked agammaglobulinaemia (XLA) is a primary immunodeficiency syndrome associated with a deficiency of B lymphocytes, caused by a defect in the expression of Bruton's tyrosine kinase. It affects only boys and usually presents before the age of 2 years with recurrent bacterial sinopulmonary infections. IgG levels are usually <2 g/L (normal range 5.4-16.1) and IgM and IgA are usually undetectable. The commonest cutaneous features of XLA are pyogenic skin infections; however, eczema can occur with increased frequency. We report a child who presented with multiple discrete eczematous lesions who subsequently developed eczematous exacerbations several days after administration of intravenous immunoglobulin (IVIg) replacement therapy.
Mycoplasma pneumonia-related EM has a distinctive presentation compared with non-MP EM, with more diffuse and atypical targets, more mucositis and respiratory tract sequelae. 6 EM is a rare hydroxychloroquine-induced cutaneous adverse reaction with generalized distribution involving trunk, abdomen, back and mucosa. 7 On another side, palmar plaques should suggest syphilis, especially in young people. 8 Both of our patients had localized acral targetoid lesions with no mucosal involvement and a negative syphilitic serology. This clinical presentation associated with chronology and evolution of eruption was suggestive of a SARS-CoV-2-related EM rather than other causes particularly hydroxychloroquine or MP. Pathophysiological mechanism could be a hypersensitivity reaction lymphocyte cells mediated with pro-inflammatory cytokines production targeting SARS-CoV-2 antigens present in skin. Limitation of our observations was a lack of histology and MP serology. Further studies are expected to validate our findings. Acknowledgement The patients in this manuscript have given written informed consent to publication of their case details.
We present a case of a 13‐year‐old boy presenting with a pruritic eruption on the ears. This had occurred two days following an outdoor sporting event on a cold but sunny day in May. A similar eruption occurred in previous years but to a lesser extent and severity, and presenting earlier in spring months. Seven days prior to this episode, he had a haircut following relaxation of the COVID‐19 lockdown restrictions. His hairstyle had previously been longer on the parietal scalp at the sides and covered the helices of the ear.
Negative-pressure wound therapy has been shown to be effective in re-epithelialisation in recalcitrant pyoderma gangrenosum. This case documents a patient whose co-morbidities limited the standard treatment options and required an alternative management plan. The STOP GAP randomised control trial found that both oral prednisolone and ciclosporin were equally effective in the treatment of pyoderma gangrenosum. However, in this case, the patient had type 2 diabetes and prednisolone resulted in persistently elevated blood glucose levels. Lower doses were ineffective and it was subsequently stopped once other treatments showed a clinical improvement. A recent diagnosis of breast cancer prevented the use of ciclosporin and other immunosuppressive treatments. After multidisciplinary discussion, involving breast surgeons, oncology, dermatology and tissue viability, doxycycline was commenced alongside a portable negative-pressure device with twice weekly tissue viability input. The introduction of this device resulted in a rapid reduction in the wound size and facilitated healing with an excellent outcome.
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