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: =ownerid&search=13102]409
Posts: =ownerid&search=13102]3,841
Posted: Mar 22, 07 - 13:43  #2
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)
dr_jojo
Forum Elite
Topics: =ownerid&search=29336]146
Posts: =ownerid&search=29336]257
Posted: Mar 22, 07 - 16:28  #3
CONFUSING !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
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| doc_clotaire
Forum Guru
Topics: 159
Posts: 1,239
|
C
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The elevator to succes is broke ,you must take the stairs
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| dr_jojo
|
i think it is SCID (bacterial , fungal , viral, prtozoal infections) but LOW Igs !!
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| eaguin
Forum Senior
Topics: 9
Posts: 162
|
I like C, Severe combined inmunodeficiency (bacterial, fungus, viral)
She is 4 months old, normally AIDS takes at least as 10 years to develop all these symptoms.
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| robin082006
Forum Hero
Topics: 471
Posts: 5,125
|
in SCID there is no lymphocyte (lack of B and T cells)
Edited by robin082006 on 03/22/07 - 11:23 PM
___________________
The Key to Succeed is Patience.
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| dr_jojo
|
I donot know in SCID how low B & T should be to diagnose
and low Igs is it one of criteria for SCID
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| nadiabarati
|
A) AIDS
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| eaguin
Forum Senior
Topics: 9
Posts: 162
|
Lymphocytes in 15 % sounds to me as a b an t cell deficiencie. Severe combined imunodeficiency is a defect in ealy stem-cell differentiation but not absolute absence of lymphocytes...
Where have you read and AIDS case that fulminant only 4 MONTHNS?
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| yasmeen
Forum Guru
Topics: 67
Posts: 936
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SCID
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| robin082006
Forum Hero
Topics: 471
Posts: 5,125
|
Kaplan qbook has a similar q, and occurs at 1 month
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The Key to Succeed is Patience.
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| webjeee
Forum Guru
Topics: 99
Posts: 349
|
i picked c
now AIDS likely
but I don't think in all SCID no T no B
T–B+NK+ SCID, T–B–NK+ SCID and T–B–NK– SCID.
Edited by webjeee on 05/09/07 - 01:25 PM
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| histop
Forum Newbie
Topics: 5
Posts: 7
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C I think !!
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| sherry39
Forum Junior
Topics: 3
Posts: 105
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