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Volume 16, Number 9—September 2010

CME ACTIVITY

Recurrent Granulibacter bethesdensis Infections and Chronic Granulomatous Disease

David E. GreenbergComments to Author , Adam R. Shoffner, Adrian M. Zelazny, Michael E. Fenster, Kol A. Zarember, Frida Stock, Li Ding, Kimberly R. Marshall-Batty, Richard L. Wasserman, David F. Welch, Kishore Kanakabandi, Dan E. Sturdevant, Kimmo Virtaneva, Stephen F. Porcella, Patrick R. Murray, Harry L. Malech, and Steven M. Holland
Author affiliations: Author affiliations: National Institutes of Health, Bethesda, Maryland, USA (D.E. Greenberg, A.R. Shoffner, A.M. Zelazny, M.E. Fenster, K.A. Zarember, F. Stock, L. Ding, K.R. Marshall-Batty, P.R. Murray, H.L. Malech, S.M. Holland); University of Texas Southwestern Medical Center, Dallas, Texas, USA (R.L. Wasserman, D.F. Welch); Children's Medical Center, Dallas (D.F. Welch); Medical City Dallas Hospital, Dallas (D.F. Welch); National Institutes of Health, Hamilton, Montana, USA (K. Kanakabandi, D.E. Sturdevant, K. Virtaneva, S.F. Porcella)

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Table A1

Features of 5 patients with Granulibacter bethesdensis infection*

Patient no. Age, y/sex Country of origin Radiographic findings Pathologic findings (site) Leukocytes, × 103 cells/μL† ESR, mm/h† Duration of signs and symptoms, wk‡ Treatment§ Recurrence
1 39/M USA Cervical, mediastinal lymphadenopathy; splenic lesions Necrotizing granulomatous inflammation (cervical lymph nodes) 11.3 90 20 Meropenem; doxycycline; TMP/SMX; ceftriaxone Relapse
2 36/M USA Cervical, mediastinal, abdominal lymphadenopathy Necrotizing granulomatous inflammation (perigastric lymph node) 10.2 50 8 TMP-SMX; meropenem; tobramycin; ceftriaxone; doxycycline; cefpodoxime; γ-interferon; tigecycline Relapse
3 13/M USA Cervical, mediastinal, lymphadenopathy Lymphohistiocytic infiltrate (transtracheal lymph node biopsy specimen) 5.9 44 4 Ceftriaxone; tobramycin; doxycycline; cefdinir Reinfection
4 17/M Panama Cervical, mediastinal lymphadenopathy Necrotizing granulomatous inflammation (cervical lymph node) NA NA 8 Doxycycline No
5 37/M USA Cervical, mediastinal lymphadenopathy; liver and splenic lesions Necrotizing granulomatous inflammation (supraclavicular lymph node) 7.3 55 16 Ceftriaxone; gentamicin; doxycycline; TMP/SMX; cefdinir No

*All patients have X-linked chronic granulomatous disease. ESR, erythrocyte sedimentation rate; TMP/SMX, trimethoprim/sulfamethoxazole; NA, not available.
†At time of patient visit or diagnosis of Granulibacter spp. infection at the National Institutes of Health, Bethesda, Maryland, USA.
‡From onset of symptoms to culture-confirmed infection; initial symptoms in those with recurrence.
§Drugs used specifically for treatment of G. bethesdensis infection alone or in combination during the patient’s illness. Drugs in boldface were those for which the largest clinical response was observed in that patient.

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