Introduction: Haemophilus influenzae has the potential to lead to invasive disease including necrotizing fasciitis, especially in immunocompromised individuals. There are only eight previous reports of monomicrobial necrotizing fasciitis due to this organism, and, to the best of our knowledge, none of the head and neck. There is also limited epidemiological and clinical data on infections caused by non-b serotypes of H. influenzae, including serotype e.Case presentation: A 60-year-old female, with systemic lupus erythematosus, Sjogren's syndrome and hypocomplementaemia, presented with rapidly progressive right-sided facial and neck pain, swelling and erythema. She was treated initially with broad-spectrum antibiotics and underwent emergent debridement of the infected tissues. Intraoperative cultures and blood cultures grew H. influenzae. She required two additional debridements and was treated with ceftriaxone for 3 weeks with resolution of her symptoms. Conclusion:Here, we present the first reported case, to the best of our knowledge, of cervical necrotizing fasciitis due to H. influenzae serotype e. This case highlights the continued clinical importance of H. influenzae as a cause of invasive disease, including necrotizing fasciitis, particularly in immunocompromised individuals. Moreover, the case provides an example of invasive H. influenzae infection caused by a non-b serotype, an emerging concern in the era of widespread H. influenzae serotype b vaccination.
Antiphospholipid syndrome (APS) is an autoimmune disorder defined by the presence of antiphospholipid antibodies associated with vascular thrombosis and obstetric complications. APS diagnosis is based on persistently (>12 weeks) abnormal coagulation tests demonstrating coagulation inhibitor (lupus anticoagulant) with or without antibodies directed against cardiolipin and/or B2 glycoprotein-I. A recent study has shown that C-reactive protein (CRP), an acute phase reactant protein with affinity for phospholipids, cross-reacts in the hexagonal phase phospholipid assay (HEX) when CRP concentrations are more than 50 mg/L. Retrospective review of the data for 496 patients evaluated for antiphospholipid syndrome was conducted. Screening included the silica clotting time assay (SCT), dilute Russell viper venom time assay (DVVT), HEX assay, and anticardiolipin antibody screen. Anti-B2 glycoprotein-I antibody testing was not performed in all samples. CRP was measured in all samples positive for HEX assay and negative for SCT and DVVT assays. Thirty patients (6.0%) had positive HEX assays with 17 positive for both HEX and SCT/DVVT assays. Of the remaining, 4 patients were positive for anticardiolipin or anti-B2 glycoprotein-I antibodies. All 9 patients positive for only the HEX assay had elevated CRP (mean, 127.1 ± 53.7 mg/L; range, 38-202 mg/L). One patient with a CRP of 38 mg/L had negative APS testing 4 months later when CRP was not elevated. Isolated positive HEX assay may be due to elevated CRP and may occur with CRP as low as 38 mg/L. Of 496 patients, no patient meeting laboratory criteria for a diagnosis of APS would have been missed had the HEX assay not been performed. Category:Hematopathology
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