| Author | 5 Posts |
dr_jojo
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A 4-month-old boy is brought to the physician because
of a 2-day
history of fever and progressive redness around his
right eye. He has had
persistent diarrhea and oral candidiasis since birth
and was treated for
pneumococcal pneumonia at the age of 2 months. He
appears ill. His
temperature is 39 C (102.2 F), pulse is 130/min, and
respirations are
25/min. Examination shows violaceous preseptal
(periorbital) cellulitis
and oral candidiasis. Laboratory studies show:
Hemoglobin 10 g/dL
Leukocyte count 3000/mm3
Segmented neutrophils 85%
Lymphocytes 15%
Platelet count 350,000/mm3
Serum
IgA <5 mg/dL
IgG 300 mg/dL
IgM <5 mg/dL
Which of the following is the most likely diagnosis?
A
) AIDS
B
) Chronic granulomatous disease
C
) Severe combined immunodeficiency
D
) Thymic-parathyroid dysplasia (DiGeorge syndrome)
E
) X-linked agammaglobulinemia
|
| robin082006
Forum Hero
Topics: 471
Posts: 5,125
|
A--> AIDS
B Chronic granulomatous disease-->rule out because mostly catalase +vinfection, this patient has pneumococcal infection (catalase -)
C Severe combined immunodeficiency-->possible, but rule out because still have WBC
D--> Thymic-parathyroid dysplasia (DiGeorge syndrome)-->rule out because mostly viral and fungal infection and hypocalcemia, this patient has bacterial infection
E X-linked agammaglobulinemia--> rule out because mostly bacterial infection, this patient also has fungal infection
why IgG high in this patient?-> may be maternal IgG (will decrease from age of 6 months)
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The Key to Succeed is Patience.
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| dr_jojo
|
CONFUSING !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
|
| maiya
Forum Newbie
Topics: 3
Posts: 35
|
B
The hallmark of CGD is early onset of severe recurrent bacterial and fungal infections. and this can't be AIDS (HIV could have been a possibility, but not AIDS).
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| fongch
Forum Elite
Topics: 71
Posts: 316
|
C looks most likely to me.
1. SCID affects lymphocyte system only.
2. This patient has defect in both cellular and humoral immunity. I think cellular immunity will be affected predominantly in AIDS
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