A 56-year-old Caucasian man complained of recurrent bilateral lower extremity cellulitis and ulcerations, requiring hospitalization and parenteral antibiotic administration. History included factor V Leiden mutation with recurrent lower extremity deep venous thromboses and recurrent MRSA urinary tract infections. He had undergone numerous abdominal procedures, with recurrent enterocutaneous fistulae and wall abscesses. Abdominal exam revealed wall ulceration with serosanguineous drainage and surrounding erythema. His lower extremities presented ochre dermatitis, bilateral +/4 edema below the knee; there were 2 ulcerations on the anterior portion of his left leg, measuring 1 × 1 cm and 2 × 3 cm (Figure ). A lower extremity ultrasound showed a left-sided nonocclusive chronic thrombus in the femoral and popliteal veins. Total levels of immunoglobulins were normal (except for a small decrease in IgG3), as were C2 and C4 (Table ). Anticardiolipin antibody was negative. The patient had a low level of MBL (<50 ng/ml), genotyping showing a LYPB/LYPB polymorphism for MBL and a wild-type MASP-2 (Table ). The patient's abdominal wall culture grew cephalosporin-sensitive Staphylococcus aureus; cultures from his lower extremity ulcerations were positive for Pseudomonas aeruginosa. The patient responded to antimicrobials, compression stockings and topical Tacrolimus©.
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.