Case history
Case history #1
A 34-year-old man presents with a 10- to 15-year history of recurrent chest and sinus infections. During this time he has been admitted to the hospital with pneumonia requiring intravenous antibiotics 3 times, and has undergone several sinus operations. He often requires >1 course of antibiotics to clear an infection, and now has a daily productive cough. On examination he is thin and pale and has signs of bronchiectasis.
Case history #2
A 9-month-old boy presents with meningococcal meningitis. He has a history of recurrent bacterial chest and ear infections and is failing to thrive. Family history reveals that he has a male cousin (maternal side) who died in infancy from infection.
Other presentations
Presenting signs and symptoms can vary greatly, dependent on the underlying diagnosis. Infants with severe combined immunodeficiency tend to present in the first few months of life with severe, life-threatening infections. Selective IgA deficiency may be asymptomatic and detected simply as an incidental finding. Common variable immunodeficiency can present with recurrent sinopulmonary infections, but may also present atypically with autoimmune phenomena such as autoimmune cytopenias and organ-specific autoimmune diseases.
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