Hyperimmunoglobulin E syndrome: Two cases and a review of the literature

• Published in: Journal of the American Academy of Dermatology 2006-05, Vol.54 (5), p.855-865
• Main Authors: DeWitt, Christine A., Bishop, Amanda B., Buescher, Lucinda S., Stone, Stephen P.
• Format: Article
• Language: English
• Subjects: Adolescent; Anti-Bacterial Agents - therapeutic use; Anti-Infective Agents - therapeutic use; Antifungal Agents - therapeutic use; Biological and medical sciences; Dermatology; Fluconazole - therapeutic use; Humans; Immunoglobulins, Intravenous - therapeutic use; Infant; Job Syndrome - complications; Job Syndrome - drug therapy; Job Syndrome - pathology; Kaposi Varicelliform Eruption - etiology; Male; Medical sciences; Prognosis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2005.10.022

Hyperimmunoglobulin E syndrome (HIES) is a rare immunodeficiency associated with elevated serum IgE levels, eczematous skin, recurrent cutaneous infections, and distinctive musculoskeletal features. We report two cases seen at our institution and review the current literature. Patient 1 was an 18-month-old African American boy with recurrent staphylococcal cold abscesses, pneumonia, and bacteremia. He had severely eczematous skin, ultimately complicated by eczema herpeticum. After treatment of systemic infections with culture-directed antibiotics, a brief course of cyclosporine, 5 mg/kg, improved the dermatitis and allowed transition to long-term therapy with oral trimethoprim-sulfamethoxazole. Patient 2 was a 15-year-old Caucasian boy with long-standing HIES. He has been maintained on a regimen of interferon gamma injections given 3 times weekly and monthly intravenous immunoglobulin since the age of 3 years, prophylactic antibiotics, and low-dose fluconazole. He has occasional episodes of cold abscesses and sinusitis, but has had excellent control since institution of this regimen and has not experienced any adverse effects.