Epidermolysis bullosa acquisita of MRSA skin carrier: a case of successful total hip arthroplasty.

PURPOSE: Epidermolysis bullosa acquisita (EBA) is a very rare disease of a chronic autoimmune subepidermal blistering, usually manifesting as skin fragility, blisters and erosions. In this article, we report a successful THA in a patient with osteonecrosis of the femoral head with EBA and methicillin-resistant staphylococcus aureus (MRSA) skin carriage. METHODS: A 59-year-old woman had severe and debilitating left hip pain due to osteonecrosis of the femoral head. She had suffered from EBA for the past 7 years. She had received several courses of intravenous steroid pulse therapy in the past, and taking 6 mg of prednisone and 100 mg of minocycline per day for infected skin blisters. Severe blisters and scars covered her body, especially at the prone area. A bacteriological examination taken using a cotton-swab returned MRSA at the nasal cavity and anterolateral part of the proximal femur. RESULTS: We employed an antibiotic prophylactic protocol used for one-stage revision for infected hip prosthesis. Primary THA was performed using the anterior approach with antibiotic-loaded cement, and the skin was fully covered with a soft and conformable foam dressing.1-year post-op, there are no signs of infection. The Harris Hip Score improved from 37 pre-op to 93.4 at 1 year post-op. CONCLUSIONS: Although care must be taken by medical professionals to avoid the prescription of unnecessary antibiotics, when used appropriately, there appears to be substantial benefits to be gained in the field of joint replacement for patients who are at high risk of infection.

Genome-wide mapping of gene-microbiota interactions in susceptibility to autoimmune skin blistering.

Susceptibility to chronic inflammatory diseases is determined by immunogenetic and environmental risk factors. Resident microbial communities often differ between healthy and diseased states, but whether these differences are of primary aetiological importance or secondary to the altered inflammatory environment remains largely unknown. Here we provide evidence for host gene-microbiota interactions contributing to disease risk in a mouse model of epidermolysis bullosa acquisita, an autoantibody-induced inflammatory skin disease. Using an advanced intercross, we identify genetic loci contributing to skin microbiota variability, susceptibility to skin blistering and their overlap. Furthermore, by treating bacterial species abundances as covariates with disease we reveal a novel disease locus. The majority of the identified covariate taxa are characterized by reduced abundance being associated with increased disease risk, providing evidence of a primary role in protection from disease. Further characterization of these putative probiotic species or species assemblages offers promising potential for preventative and therapeutic treatment development.