The patient is a 6-year-old male with multiple medical problems and was referred to the clinic to evaluate apparent weak

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The patient is a 6-year-old male with multiple medical problems
and was referred to the clinic to evaluate apparent weakness and
recurrent pulmonary infections.
The patient had had severe pneumonia eight times during the
previous six years, including three episodes necessitating hospital
admission. Each infection was characterized by the sudden onset of
fever with a temperature as high as 103°F., shaking chills, nausea,
anorexia, and subcostal chest pain. A persistent chronic cough had
been present for two years, yielding approximately a half cup of
yellow-green sputum daily with occasional blood streaking. Studies
for acid-fast organisms in the sputum had been negative.
He had received antibiotic treatment on numerous occasions because
of recurrent sinusitis.
The patient gradually lost 5 pounds in weight during the two years
before admission, with associated increasing weakness. Nine weeks
before entry, explosive diarrhea developed, with the passage of six
watery stools every morning and one or two every evening; there was
no nausea, vomiting, and no mucus was observed in the stools.
On several occasions, the diarrhea was preceded by crampy lower
abdominal pain. There was no specific food intolerance.
Physical examination revealed a thin, pale child weighing 32
pounds who appeared chronically ill. Several nontender
posterior cervical nodes and numerous 1-cm Inguinal nodes were
palpable bilaterally. The anteroposterior diameter of the chest was
increased, and the thorax was hyper resonant. The breath sounds
were slightly decreased at the bases, and numerous rhonchi were
audible, especially during expiration. The heart was not enlarged.
The abdomen was flat and taut; the bowel sounds were normal. The
liver was normal. There was mild pitting edema of the ankles. The
neurologic examination
was negative.
The table below shows the results of the patient's laboratory
work. The values between parenthesis are the reference normal
values.
Blood Group
O Positive
Antibody screening
Negative for anti-nucleus antibodies
(autoimmunity
Serum IgA
0.8 mg/dL (90-325 mg/dL)
Serum IgG1
2.4 mg/dL (500-1200 mg/dL)
Serum IgG2
1.6 mg/dL (200-600 mg/dL)
Serum IgG3
0.6 mg/dL (50-100 mg/dL)
Serum IgG4
0.8 mg/dL (50-100 mg/dL)
T lymphocyte count
1200 cells/mm3 (500-1600cells/mm3)
B lymphocyte count
140cells/mm3 (100-320cells/mm3)
1. What is the diagnosis considering his clinical history and
the results of the above investigations (Name of the disease)?
2. If you have to choose one strategy to prevent pulmonary
infection in this particular patient, would you pick the
pneumococcal vaccine or prophylactic antibiotic therapy? Choose
one, and explain your choice.
3. What is the likely explanation for repetitive episodes of
pneumonia?