Recurrent Pneumonia 2_9_2011

Images of an 11 yo boy

9/14/10 Atelectasis and blunting of left costophrenic angle

9/30/10 Middle lobe atelectasis

Right pleural effusion Atelectasis Possible infiltrate 11/26/10 Right pleural effusion Atelectasis Possible infiltrate

12/10/10 Infiltrate on right Possible LAD

1/4/11 Left pleural effusion and infiltrate

1/9/11 Organizing pleural effusion

… and now the H & P Multiple pneumonias during the past year, all with fever. Antibiotics seem to help. “Asthma” not responsive to albuterol and inhaled corticosteroids Several sinus infections Normal growth and weight gain; no draining ears, skin infections, diarrhea, etc. These pneumonias seem real as they are in different areas, present with fever, and respond to antibiotics

PAST MEDICAL HISTORY Mild Asperger's syndrome, tic disorder ITP and IgA deficiency in the first 1-2 years of life. Treated with steroids.

Physical Examination Ht 24%ile, Wt 47%ile, P 127, R 24, BP 124/67, T 38.3 C, O2 Sat 96% Appears sl flushed, no distress; somewhat wide bridge of the nose. Decreased breath sounds L base Otherwise unremarkable

Laboratory Studies IgG < 60, IgA 0, IgM 13 Streptococcus pneumonia urine ag +

Got the paper medical record @ 2 years of age IgG 374 (423 – 1184 mg/dl) IgM 10.4 (32- 131mg/dl) IgA < 7 (4-123 mg/dl) ITP can predispose to immunoglobulin deficiency and common variable immune deficiency later in life!!! Treat this patient with IVIG