Justice
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A 51-year-old male accountant is being treated for his third episode of pneumococcal pneumonia in the last 15 months. Prior to the first episode, he had never had a major illness and had never been hospitalized. There have been no significant personal or occupational changes and no history of recent travel. His children are grown and live away from home.
Physical examination and a chest radiograph are consistent with right lower lobe pneumonia. A CT scan of the chest shows no endobronchial or other mass lesions. The leukocyte count is 14,500/μL with a slight left shift. Determination of lymphocyte subsets shows a normal ratio of CD4/CD8 cells. Total hemolytic complement (CH5O) determination is normal. Serum protein electrophoresis shows gamma globulins in the low-normal range without a monoclonal spike.
Which of the following disorders is the most likely cause of this patient’s multiple episodes of pneumonia?
A. Terminal complement component deficiency
B. Bronchogenic carcinoma
C. Common variable hypogammaglobulinemia
D. Multiple myeloma
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| dr.wad
Forum Senior
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C...late onset immunodeficiency
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| peter90036
Forum Elite
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c
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| cool doctor
Forum Junior
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B
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| arlete
Intern in 2009!!!!!
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c
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| CocaCola
Forum Guru
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C
its an immune deficiency... not a complement deficiency because total hemolytic complement level are normal... not multiple myeloma because there is no monoclonal spike on electrophoresis...
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| milestogo
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b? i thought c but cvd so late????:confused
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| aspire
Forum Senior
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C-Common variable hypogamma globulinemia.
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| Markus2009
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C
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| Justice
Forum Fanatic
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The correct answer is C
The most likely diagnosis of those given is common variable hypogammaglobulinemia. The clinical picture is typical, and the serum protein electrophoresis results are suggestive, although not conclusive, for this disorder because of the low gamma globulin values.
The remaining laboratory results are not consistent with any of the other diagnoses. The normal total hemolytic complement (CH50) value effectively rules out terminal complement component deficiencies, and, in any event, such deficiencies would not be expected to lead to bacterial pneumonia. Although bronchogenic carcinoma is a cause of postobstructive pneumonia, this diagnosis is not suggested by the radiographic findings and time course of this patient’s disorder. Multiple myeloma is usually, although not always, accompanied by a monoclonal spike in the gamma globulin region. Some patients with a predominance of light chain production may have a normal serum protein electrophoresis. Since none of the tests performed to date definitively rules out any of the potential diagnoses, quantitative serum immunoglobulin determination should be done next.
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