What could cause recurrent skin infections and boils?

Question

Hello doctor,

I keep getting quite a bad infected sore on my skin, like a small pimple with a little pus initially, which then gets infected. About 14 months ago, I got one of these on one side of my leg and the middle of the upper thigh. It got worse over a few days and then blew up very infected, and I went to the hospital and had to have four IV (intravenous) antibiotic drips. I was there for about 36 hours at the hospital. The entire upper leg was swollen down to my knee. The diagnosis was cellulitis.

These have all cleared up by themselves over about two to three weeks, but were red and some with red radiating outward on my skin, but I was able to fight off the infection. I have also had a rash under my left armpit several times. I had a more severe one near my left elbow about three months ago, and the infection was spreading up my arm. So, I got oral antibiotics from the doctor, and it cleared in about four days.

I have just now, in the last few weeks, had another near my left elbow (still there and very sore), and a second one appeared nearby about five days ago. I had not taken antibiotics for about 15 years before the first leg episode about 14 months ago. I have changed my diet a lot to be eating very healthy for the past 12 months.

I am not eating many complex carbohydrates (rice, bread, pasta) and stick mainly to lots of green vegetables and good protein like grass-fed meat, free-range chicken, salmon, and free-range eggs. I guess sometimes I may go in and out of ketosis a bit. When I drink, I drink a fair bit (15 standard drinks), but only do this once a week. Unsure if this is related.

Hoping to get to the bottom of this.

Thanks.

Answer 1

Hello,

I am glad you chose iCliniq for your medical-related queries.

I understand your concern and will try to help you with it.

It seems like a frequent case of bacterial infection of your skin. Why are you frequently getting bacterial furunculosis is what we need to look at. This usually indicates an immunocompromised state or underlying uncontrolled diabetes mellitus or a complement deficiency disorder.

What I can gather from your symptoms is that you get bad cases of furunculosis, some with infected axillary lymphadenopathy (the tender lumps in the axilla). The axillary rash is something else that also occurs in diabetics or immunocompromised individuals. It is called erythrasma. It also occurs with obesity, as in your case. It would be helpful to know a bit more about your condition, like

Has this ever happened when you were a child?
Did you get frequent infections as a child, or is it something that happened only recently?
Do you have diabetes mellitus or a family history of diabetes?

Given your BMI, you are very prone to insulin resistance. Hence, we need to take a look at your blood glucose levels. I am very hopeful we can get to the bottom of this. We need to look at it in a stepwise manner, ruling out possibilities and establishing a diagnosis.

Please give me the details I asked for and get the following investigations done.

Oral glucose tolerance test.
HbA1c.
Full blood count.

If these turn out to be normal, then we have to check your complete immunoglobulin levels.

Thank you for consulting me.

You can always reach me at icliniq.com.

Answer 2

Hello,

Welcome back to icliniq.com.

I read and understand your concern.

I am always glad to be of help. Now I have taken a good look at the reports (attachment removed to protect patient identity). Your WBC has always been within the range. So, it is normal. In fact, other than the lipid profile, the rest are fine. If it is a Methicillin-resistant staphylococci aureus, I understand he must have put you on Vancomycin.

However, we need to figure out why this is happening. Since your blood glucose is normal, we need to see if the complement levels are normal. But it would be helpful to know if you have always suffered from frequent infections as a child or only for the last 14 months. If always, then we need to get your complement levels checked. If not, then it is probably a bad case of Methicillin-resistant Staphylococci infection.

Looking forward to your response in order to help you.

Thank you.

Answer 3

Hello,

Welcome back to icliniq.com.

I read and understand your concern.

Those are IgG, IgA, and IgM, and complement component levels. But if you have never had recurrent infections since childhood, then the possibility of an underlying congenital deficiency is less. However, it could be acquired. Hence, it is better to get them checked as such deficiency disorders are frequently associated with bacterial infections.

Looking forward to your response in order to help you.

Thank you.