Cutaneous manifestations of hyper-IgE syndrome in twins: a case report from Saudi Arabia.

Twin brothers aged 9-years were seen over a period of 5-years and were diagnosed and treated as atopic dermatitis. They came to our attention due to repeated exacerbations of dermatitis and multiple skin abscesses. Physical examination showed that both the brothers had coarse facial appearance with prominent brow and deep-set eyes (Figure 1). There were papulopustular lesions all over the body especially on the face and scalp (Figure 2). These bouts of infections had no seasonal variation and was present to some degree at all times. The elder twin always had more extensive eczema with secondary infections, as such his physical growth was less as compared to his twin brother as shown in the (Figure 1). Recurrent small and large skin abscesses were also observed during bouts of exacerbation (Figure 2). Both the brothers had repeated attacks of conjunctivitis with purulent discharge resulting in dry scabs along the eyelid margins which is clearly visible in (Figures 1 and 2). In addition to that they suffered from recurrent attacks of uni or bilateral ear infections, cultures taken from the ear were positive for Staphylococcus aureus, Streptococcus pneumoniae and on one occasion for Pseudomonas aeroginosa. They also suffered from frequent attacks of candidiasis mostly in the groin responding dramatically to local anti fungal ointments. The mother gave the history that her sons were suffering from repeated episodes of skin infections since infanthood, there was also history of cough, fever and breath-