CINIII
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Topics: 34
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i saw this being discussed......but cant find the thread now.
can anyone suggest the ans?
D?
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| cirus
Forum Guru
Topics: 108
Posts: 740
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Yes D
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| CINIII
Forum Senior
Topics: 34
Posts: 64
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can u plz give reasoning for the answer?
Butrron's starts after 6 months.....but pt is 6 months and had had infections in past.
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| young_doc
Forum Guru
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Diarrhea, pulmonary problems, white plaques in mouth, diffuse adenopathy...this doesn't sound like Bruton's.
Almost sounds like HIV (oral candidiasis, generalized adenopathy, chronic diarrhea...)?
But then again, CGD also can have adenopathy, GI and pulmonary infection...
Tough Question!
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| dermatology
Forum Elite
Topics: 30
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i wud go for C ........ looks like opportunistic infection due to hiv ... but not sure whether hiv comes positive at this age .....
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| khorshid
Forum Guru
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to me it sounds like HIV, CGD doesn't give white plaques. And as far I remember HIV can show up at this age, correct me if I'm wrong
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| elitoki
Forum Guru
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I think I will go with Bruton agammaglobulinemia.
Both, HIV and Bruton can give any kind of symptoms that was described, but there aren't any sign of maternal HIV predisposition and usually is Dx on first year of life, and bruton is present with x-linked. Maybe, am I wrong?
Edited by elitoki on 07/06/07 - 03:34 PM
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| cirus
Forum Guru
Topics: 108
Posts: 740
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ok now i think the ans is C
the most imp factor for immune defs is absent which is recurrence of infec, so i think HIV testing should be the appropriate, the second factor is that she has developmental delay that points more to HIV (10 th perc of weight)
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| dr in trouble
Forum Guru
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yes it is C
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| rezaaa
Forum Senior
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i thot it was brutons the main thing going against it is the diffuse adenopathy.
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| rezaaa
Forum Senior
Topics: 8
Posts: 149
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i was thinking SCID rather than brutons but i guess hiv is a good choice, just that they should have given some history of mother with hiv or somethin
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| lgv
Forum Newbie
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Case in short: 6 months with Diarrhea, respiratory failure, white plaques in mouth, diffuse adenopathy: Differential Diagnosis: 1) HIV (oral candidiasis, generalized adenopathy, chronic diarrhea, malnutrition and respiratory failure(pneumocystis) favor HIV infection (there isn't any h/o of maternal HIV), further presentation and onset at this age is not uncommon and is more common than CGD. Hence due to a higher positive predictive value for the HIV test I would first do a HIV. In the absence of a positive test I would consider CGD 2) CGD is a possibility and can have adenopathy, GI involvement and pulmonary infection... About two thirds of cases are inherited as X-linked defects, and the remaining cases are inherited in autosomal recessive fashion( no information available). The vast majority present with infections in early childhood. Fungal infections occur in up to 20% of patients with CGD. Pneumonia is the most common presentation. Torulopsis glabrata (ie, Candida glabrata), and Candida albicans are common. In a 2004 review of 140 patients with CGD, 33% had GI involvement, including granulomatous colitis, Crohnlike inflammatory bowel disease (IBD), GI obstruction (gastric, esophageal, duodenal, or other locations), perianal abscesses or fistulas, and esophageal dysmotility. Symptoms included abdominal pain (100%), diarrhea (33%), nausea and vomiting (24%), bloody diarrhea (6%), and constipation (4%) (Marciano, 2004). Chronic or recurrent infections in childhood can lead to failure to thrive with impairment of physical growth, though most adults with CGD appear to attain their expected growth potential. 3) Bruton’s agammaglobulinemia: Usually x-linked (no information given) and no lymphadenopathy – so not Bruton’s.The remaining choices given do not seem to be of any direct significance.
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| liliaeliz
Forum Elite
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 C because candida no is i CGD
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| sandra
Forum Guru
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i think its CGD. 6 months, infections with catalase producing organisms ( oral ulcers by canidida which is catalase positive) all point towards CGD. so i would say...E. nitoblue....test.
what do u say guys?
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| DrAlex_76
Forum Junior
Topics: 5
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go for E. NBT test
boy child, growth failure, chornic diarrhea, Septicemia, lung infection, fungal infection, and LYMPHADENOPATHY .
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| PGI2alpha
Forum Elite
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they have specifically said in the question tht the child had DRY cough with no preceding congestive symptoms....points more towards PCP. PCP+ candida + chronic diarrhea...i will get an HIV test first...
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