title: A Twenty-Three-Year-Old Man with a Chronic Anterior Chest Wall Wound, Eosinophilia, and Elevated IgE-Job's Syndrome.
abstract: A 23-year-old man presented with a chronic anterior chest wall wound. Previously he had a split thickness skin graft in the area in where the wound bed had become infected, developing a thick purulent drainage. The infected skin graft was excised. Histologic examination of the failed graft revealed skin with surface ulceration, focal abscess formation, deep penetrating acute and chronic inflammation with numerous eosinophils, and granulomatous changes demonstrating a foreign body-type reaction to fungal hyphae (highlighted by periodic acid-Schiff staining, Figures 1A-E). The patient's past medical history included scoliosis, acute lower back pain, right shoulder degenerative joint disease, atopic dermatitis, lymphadenitis, rhonchi, insomnia, depression, and a long history of recurrent infections, particularly cutaneous staphylococcal and candida albicans infections, often accompanied by a purulent drainage. Review of the patient's laboratory studies revealed chronically elevated alkaline phosphatase, with highly elevated serum IgE (2,922 IU/ml) and eosinophilia (925/μL3) since childhood. Other lab studies were unremarkable, except for episodic elevations of the white blood cell count. The patient's family history was largely unremarkable and the patient's parents and siblings had no histories of unusual infections.
authors.affiliation: Department of Pathology, LSU Health Shreveport, LA.
authors.forename: R
authors.initials: R
authors.lastname: Shackelford
authors.affiliation: Department of Pathology, LSU Health Shreveport, LA.
authors.forename: J
authors.initials: J
authors.lastname: Abdulsattar
authors.affiliation: Department of Pathology, LSU Health Shreveport, LA.
authors.forename: J
authors.initials: J
authors.lastname: Aufman
authors.affiliation: A medical student at the LSU Medical School Shreveport, LA.
authors.forename: E
authors.initials: E
authors.lastname: Madrid
authors.affiliation: Department of Pathology, LSU Health Shreveport, LA.
authors.forename: J
authors.initials: J
authors.lastname: Cotelingam
authors.affiliation: Department of Pathology, LSU Health Shreveport, LA.
authors.forename: K
authors.initials: K
authors.lastname: Hookim
mesh_terms: D000469:Alkaline Phosphatase / Q000097:blood; D002908:Chronic Disease; D004802:Eosinophilia / Q000276:immunology*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D007589:Job Syndrome / Q000150:complications* / Q000276:immunology; D008297:Male; D009181:Mycoses / Q000276:immunology / Q000382:microbiology; D035441:Thoracic Wall / Q000293:injuries*; D014946:Wound Infection / Q000276:immunology* / Q000382:microbiology; D055815:Young Adult
chemical_list: D007073:Immunoglobulin E; D000469:Alkaline Phosphatase