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A 15-month-old boy is brought to the office due to 3 days of fever. In the past 9 months,
he has had 4 episodes of otitis media and 2 episodes of lobar pneumonia, one of which
required hospitalization and prolonged intravenous antibiotic therapy. The patient is at
the 40th percentile for weight. His temperature is 38.2 C (100.8 F). Physical examination
shows a bulging, erythematous tympanic membrane on the right side but is otherwise
unremarkable. The patient's laboratory studies are as follows:
Leukocytes 8,000/mm•
Neutrophils 6,000/mm'
Lymphocytes 2,000/mm'
CD4• T cells 1,150/mm' (640-11 75/mm')
CDS• T cells 810/mm' (335-875/mm')
Immunoglobulins
lgG 80 mg/dL
lgA 31 mg/dL
lgM 11 mg/dL
lgE 18 mg/dL
Which of the following is the most likely diagnosis for this patient?
0 A. Bruton agammaglobulinemia
0 B. Common variable immunodeficiency
0 C. DiGeorge syndrome
0 D. Severe combined immunodeficiency
0 E. Transient hypogammaglobulinemia of infancy
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a. ld : 3195
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lab Values
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A 15-month-old boy is brought to the office due to 3 days of fever. In the past 9 months,
he has had 4 episodes of otitis media and 2 episodes of lobar pneumonia, one of which
required hospitalization and prolonged intravenous antibiotic therapy. The patient is at
the 40th percentile for weight. His temperature is 38.2 C (100.8 F). Physical examination
shows a bulging, erythematous tympanic membrane on the right side but is otherwise
unremarkable. The patient's laboratory studies are as follows:
Leukocytes 8,000/mm•
Neutrophils 6,000/mm'
Lymphocytes 2,000/mm'
CD4• T cells 1,150/mm' (640-1175/mm')
CDS• T cells 810/mm' (335-875/mm')
Immunoglobulins
lgG 80 mg/dL
lgA 31 mg/dL
lgM 11 mg/dL
lgE 18 mg/dL
Which of the following is the most likely diagnosis for this patient?
Explanation: User
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a. ld : 3195 PreVIOUS Next lab Values Notes Calculator Reverse Color Text Zoom
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B cell
Condition lgG lgA lgM lgE
count
Common variable
Normal I I I I
immunodeficiency
Job syndrome
Normal Normal Normal Normal I
(hyper-lgE syndrome)
X-linked agammaglobulinemia I I I I I
© UWortd
References:
1. Overview of immunodeficiency disorders
2. X-linked agammaglobulinemia.