VCOM Research Day Program Book 2023

Medical Resident Research Case Reports

25 Gotta Catch ‘Em All: A Case Report of Congenital Ichthyosis – Epidermolytic Hyperkeratosis with Recurrent Bacteremia

Stephen M. Pillinger, DO; Leo Andrada, OMS III; Amber Stephens, DO; Bryan Conder, DO Corresponding author:

SOVAH Health Family Medicine Residency Program

go to the ER and was subsequently placed on TMP/ SMX and advised to follow up. At follow-up, the patient underwent repeat cultures resulting in Group B Streptococcus and MSSA. The patient was hospitalized for bacteremia. A central line was placed, and the patient was discharged on IVAntibiotics: Daptomycin for 12 days with periodic CPK monitoring. The patient was encouraged to follow up with a Dermatologist for further management of Epidermolytic Hyperkeratosis CI to help manage bacterial colonization and recurrent bacteremia. Diagnosis: MSSA and Group B Streptococcus bacteremia without sepsis secondary to recurrent bacteremia. Treatment: Outpatient IVAntibiotics: Daptomycin, Supportive Management of Epidermolytic Hyperkeratosis. Comment: The patient’s recurrent bacteremia stemmed from bacterial colonization due to his Epidermolytic Hyperkeratosis CI. The patient was previously diagnosed with Serratia Bacteremia before being diagnosed with Group A Streptococcus Bacteremia, MSSA, and then Group B Streptococcus. Bacterial colonization of the scaling and thickened skin seen with Epidermolytic Hyperkeratosis

is suspected of causing the patient’s recurrent bacteremia, foul-smelling odor, and superinfection. Improved management of his Epidermolytic Hyperkeratosis through supportive management would likely decrease complications. Conclusion: The patient’s recurrent bacteremia is suspected to be secondary to his Epidermolytic Hyperkeratosis. While treating bacteremia with the appropriate antibiotic based on culture and susceptibilities, management of CI is mainly supportive, consisting of long bathtub soaks to help remove scaling. Intermittent diluted bleach baths can help decrease the colonization of pathogenic microbes and odor associated with hyperkeratosis. Petrolatum and other emollients, humectants, and keratolytics can also help soften and remove scale. Systemic retinoids can also be used for severe hyperkeratosis.

Context: Congenital ichthyosis (CI) consists of a rare group of inherited disorders characterized by disrupted integumental formation causing hyperkeratosis and scaling of the epidermis. Disease prevalence ranges from 1:250 births to 1:200,000 births and spans a variety of inheritance patterns. There is no definitive treatment for CI, as management remains primarily supportive. Epidermolytic Hyperkeratosis is a subtype of CI which presents with erythroderma, blisters, and erosions that form into hyperkeratotic skin changes over time. Complications arise due to impaired skin barrier function, which leads to dehydration, electrolyte abnormalities, bacterial colonization, foul odor, sepsis, and superimposed infections. Case Report: A 55-year-old Caucasian male with a past medical history of Congenital Ichthyosis – Epidermolytic hyperkeratosis subtype, gout, hypereosinophilia, elevated IgE, anxiety, chronic pain, and recent previous diagnosis of Serratia Bacteremia. He presented to the Family Medicine clinic for a follow-up on a new diagnosis of Group A Streptococcus Bacteremia after being seen in the ER for shoulder pain and swelling. The patient was discharged on oral antibiotics. Repeat Blood cultures were positive for MSSA. He declined to


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