tacrolimus and Abscess

Pyoderma gangrenosum is an inflammatory disease that has been found to be associated with many systemic illnesses. The case presented here is of a man with a 20-year history of hidradenitis suppurativa who developed pyoderma gangrenosum. The pyoderma lesions appeared as a single outbreak which resolved totally after immunosuppressive treatment. This association has been reported only rarely in the literature. Furthermore, in the cases reported, no relationship was apparent between the activity of both diseases. In all cases the clinical course appeared independent, with no apparent overlap in inflammatory activity or response to the drugs administered.

Topics: Abscess; Adrenal Cortex Hormones; Anti-Bacterial Agents; Antibodies, Monoclonal; Cyclosporine; Drug Therapy, Combination; Hidradenitis Suppurativa; Humans; Immunosuppressive Agents; Infliximab; Male; Middle Aged; Pyoderma Gangrenosum; Retinoids; Skin Ulcer; Tacrolimus

Thrombotic microangiopathy (TMA) is a rare complication associated with the use of calcineurin inhibitors in lung transplantation, irrespective of the underlying disease of the graft recipient. It usually occurs in incomplete forms, complicating and delaying diagnosis until damage is already irreversible. It is unrelated to time from transplantation and often presents with concomitant infection, which tends to confound diagnosis. The cases discussed here have a common causative agent and all present with concomitant infection. Treatment recommendations have changed in recent years with the introduction of plasmapheresis or, more recently, the availability of the antibody eculizumab. Notwithstanding, the most cost-effective measure is withdrawal or switching of the calcineurin inhibitor. TMA is an underdiagnosed clinical entity that should be considered in the management of transplantation patients.

Topics: Abscess; Candida glabrata; Candidiasis; Creatinine; Disease Susceptibility; Drug Substitution; Erythrocytes, Abnormal; Everolimus; Female; Hemoglobins; Humans; Immunosuppressive Agents; L-Lactate Dehydrogenase; Lung Transplantation; Male; Middle Aged; Myositis; Nocardia Infections; Platelet Transfusion; Pneumonia; Postoperative Complications; Tacrolimus; Thrombotic Microangiopathies; Young Adult

Nocardia thyroid abscess with pneumonia is a rare clinical presentation. We reported a liver transplant recipient with Nocardia thyroiditis and pneumonia after receiving high dose immunosuppressants to preserve his graft. The patient is a 50-year-old male who developed hepatitis C virus-related liver cirrhosis and received a liver transplant. Seven months post-transplantation the patient developed graft rejection, which was treated with 3 days pulse dose methyl-prednisolone followed by an increased dose of his tracolimus, mycophenolate and prednisolone. He presented to the hospital with a 2 week history of fever, tenderness in his anterior neck and dry cough. On admission his temperature was 39.5°C. The right wing of his thyroid gland was swollen to 3 cm in size, fluctuant and tender. On auscultation of his lungs there were fine crepitations and increased vocal resonance in the right middle lung field. On laboratory testing, a complete blood count (CBC) revealed leukocytosis (19,900/mm3) with neutrophils (97%). A chest X-ray showed an patchy infiltrates and round circumscribed densities in the superior segment of the right lower lobe of his lung. A CT scan of his neck revealed a diffusely enlarged right wing of the thyroid gland, 3.8 cm in diameter that had an abnormal hyposignal area. A CT of his chest revealed consolidation of the superior segment of the right lower lobe and necrotic right paratracheal lymph nodes with inflamed strap muscles. Fine needle aspiration of the right lobe of thyroid gland was performed. Modified acid-fast bacilli (MAFB) staining showed partially acid-fast beaded branching filamentous organisms and a culture grew out Nocardia asteroides. He was treated with trimethoprim-sulfamethoxazole for 6 months. He improved clinically and his chest X-ray also cleared.

Topics: Abscess; Fever; Graft Rejection; Humans; Immunosuppressive Agents; Liver Transplantation; Male; Middle Aged; Mycophenolic Acid; Nocardia Infections; Pneumonia, Bacterial; Prednisolone; Tacrolimus; Thyroiditis

Perianal abscess (PA) and fistula-in-ano (FIA) are common acquired anorectal disorders in children, but their management is still controversial. This study was performed to evaluate our experience with the treatment of PA and FIA in children of different age groups.. A retrospective study was conducted of children below 16 years of age treated for PA/FIA in a pediatric surgery center between January 2002 and April 2006. The standard treatment for PA was incision and drainage (I&D). Judicious probing for fistulae was only performed in recurrent abscess or if a discharge of pus was identified from the anal verge at surgery. Fistulotomy was routinely performed in low fistulae not associated with inflammatory bowel disease (IBD). IBD associated fistulae were treated with topical tacrolimus in the absence of deep seated infection. Patients were divided into 3 age groups: <2 years, 2-8 years and >8 years. Mode of treatment, microbial organisms, recurrence, associated FIA and association with IBD were recorded. The median follow-up period was 6 months (8 weeks-3 years). Fisher's exact test was used for the analysis of categorical variables.. A total of 78 (39 [<2 years]; 17 [2-8 years]; 22 [>8 years]) patients were treated for PA/FIA during the four year period. In children aged <2 years, 33 (85%) had I&D of PA and the other 6 (15%) had fistulotomy. Recurrence was seen in 9 (23%) children, of which 3 (8%) had FIA. In children aged 2-8 years, 13 (76%) had PA and 4 (24%) had a FIA and there were no recurrences. In children >8 years, 12 (55%) had I&D, 1 (4%) had a fistulotomy and 9 (41%) were treated non-surgically. Six of 7 patients with IBD associated FIA were treated successfully with topical tacrolimus. The recurrence rate after primary surgery was significantly higher for <2 years and >8 years age groups compared to the 2-8 years age group. The incidence of FIA identified either at primary operation or during exploration for recurrence was highest (50%) in >8 years age group and lowest (21%) in the <2 years age group. Lactose fermenting coliforms were the most common organisms isolated from pus. The presence of intestinal organisms in pus was associated with significantly higher recurrence rates in children aged <2 years.. Surgery for PA/FIA in children aged <2 years resulted in low recurrence rates and should be considered as the primary treatment. Topical tacrolimus was found to be an effective treatment for IBD associated FIA.

Topics: Abscess; Administration, Topical; Adolescent; Anus Diseases; Child; Child, Preschool; Combined Modality Therapy; Female; Humans; Immunosuppressive Agents; Infant; Infant, Newborn; Inflammatory Bowel Diseases; Male; Rectal Fistula; Recurrence; Retrospective Studies; Tacrolimus; Treatment Outcome

Topics: Abscess; Administration, Topical; Aged; Humans; Immunosuppressive Agents; Male; Skin Diseases, Bacterial; Tacrolimus