Recurrent Infections in a 5-Year-Old Boy

Nicholas Bennett, MBBChir, PhD


July 30, 2018

Physical Examination and Workup

Upon examination, the patient is slim. He weighs 35.2 lb, which is at the 10th percentile for weight, and is 43.3 inches tall, which is at the 50th percentile for height. He is well nourished, well developed, and in no acute distress. His temperature, taken orally, is 101°F. Heart and respiratory rates are normal. Craniofacial features appear within normal limits.

Otic examination reveals an occluded ear canal with purulent drainage. His left tympanic membrane is erythematous, with some purulent fluid draining through the properly positioned PE tube. The right tympanic membrane appears normal. His cardiac, respiratory, abdominal, musculoskeletal, and skin examination findings are within normal limits. No abnormal findings were present as a result of the recurrent pneumonias. He had no hepatosplenomegaly. Palpable, nontender lymph nodes are noted along his anterior cervical chain (1-2 cm in size); none are found elsewhere. To help further define the diagnosis beyond the current presentation, the following laboratory studies were obtained:

  • White blood cell count of 10.4 x 109/L

  • Hemoglobin level of 12.2 g/dL

  • Platelet count of 230 x 109/L

  • Neutrophils 54% (absolute neutrophil count, 230/mcL)

  • Immunoglobulin G (IgG) level of 450 mg/dL (reference range, 500-1000 mg/dL)

  • Immunoglobulin A (IgA) level of 26 mg/dL

  • Immunoglobulin M (IgM) level of 145 mg/dL

Extremely high titers (14 µg/mL, 23 µg/mL, and >84 µg/mL) to 3 of 14 pneumococcal serotypes, and lacking protective titers to all other pneumococcal serotypes.


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