A 61-year-old man presented with recurrent folliculitis-like eruptions of the skin. His history was significant for a prior history of infection of the cheek with methicillin-resistant Staphylococcus aureus (MRSA) treated with minocycline. Six years earlier, he had suffered infection of a pacemaker site with MRSA, which had spread to his upper extremities, but was ultimately controlled with antibiotics. He denied intravenous drug use. Physical examination revealed a 1-cm indurated nodule over his left cheek, a 5 × 3 cm hyperpigmented patch over his left ankle, and scattered areas of erythema over his anterior chest wall and dorsum of his legs. MBL level was < 50 ng/ml, while all classes of immunoglobulins were within normal range (Table ). MBL genotyping revealed the LYPB/HYPD haplotypes. MASP-2 genotype was the wild type (A/A). MBL functional pathway test was impaired (Table ). A skin biopsy of the folliculitis-like rash (Figure ) was performed, revealing Grover's disease (transient acantholytic dermatosis). Topical therapy was instituted with triamcinolone.
49-year-old woman with complaints of a blistering skin eruption and hyperpigmentation for the past 6 years; the lesions were thick, tender, indurated, and presented with yellow-green secretion. Her past medical history included recurrent impetigo, perennial rhinitis, and ulcerative colitis. On exam, a 1-inch area of induration and erythema was observed over her chin (Figure and ); there were multiple scattered pustular lesions over the forearms, some ulcerated. Encrusted pustules were also observed over her scalp, face, back and legs. Work-up yielded a weakly positive ANA and an elevated CRP (10 mg/L) (Table ). MBL levels were low at < 50 ng/ml. Punch biopsy from her forearm (Figure ) revealed histopathology and morphology compatible with Candida sphaerica, although the possibility of Trichophyton rubrum was also raised; cultures were attempted from a specimen but no growth was observed. An aspirate of one of the pustules grew Sphingomonas paucimobilis. Terbinafine and levofloxacin were given, and her eruption resolved. Genotyping revealed LXPA/LYPB for MBL and A/G for MASP-2 (Table ). The MBL functional assay was also impaired.