1. Recurrent Pneumonia
2_9_2011

2. Images of an 11 yo boy

3. 9/14/10
Atelectasis and blunting of left costophrenic angle

4. 9/30/10
Middle lobe atelectasis

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

6. 12/10/10
Infiltrate on right
Possible LAD

7. 1/4/11
Left pleural effusion and infiltrate

8. 1/9/11
Organizing pleural effusion

9. … 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

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

11. 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

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

13. Got the paper medical record @ 2 years of age
IgG 374 (423 – 1184 mg/dl)
IgM ( mg/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