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©.
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.