Neutrophil chemotaxis in two patients with recurrent staphylococcal skin infections and hyperimmunoglobulin E

Defective neutrophil chemotaxis and elevated serum IgE are found in some children with recurrent staphyloccal infections. We have serially studied neutrophil chemotaxis in two such patients. Patient 1, an 18-year-old white girl, has had recurrent, painless, "cold" staphylococcal skin abscesses and chronic otitis media since infancy. Patient 2, a 3-year-old Negro boy, has had atopic dermatitis, asthma, and painful staphylococcal skin abscesses for 2 years. In both patients, serum immunoglobulins and complement were quantitatively normal except for serum IgE, which was 25,000 and 45,000 ng/ml, respectively (normal 60 to 600 ng/ml). Only one of three delayed-hypersensitivity skin tests was positive in Patient 1, whereas all three were negative in Patient 2. Both patients' lymphocytes responded normally to mitogens in vitro. Phagocytosis and killing of S. aureus by both patients' neutrophils were normal. In contrast, neutrophil chemotaxis was markedly abnormal. Chemotaxis was impaired toward serum chemotactic factor(s) but not toward two bacterial chemotactic factors. Kinetic studies suggested that the rate of migration of the patients' neutrophils towards serum chemotactic factor(s) was diminished. On repeated testing, the chemotactic defect was found to be intermittent. Our findings suggest that defective neutrophil chemotaxis is acquired rather than intrinsic to the cell. Furthermore, the abnormality is selective. These findings emphasize the importance of studying patients not only serially but with several different chemotactic factors.