Pediatrics Recalls By Subject – immunology

Which of the following patients is suspected of being immunodeficient?

An 8-year-old with known epilepsy for about 2 months. Presents with an itching rash and fever of 38°C.

He has been treated for seizures with lamotrigine (lamictal) over the last 4 weeks, with a good response. Examination reveals the rash seen in the picture, erythema in the pharynx, and enlarged cervical lymph nodes.

Laboratory tests are positive for elevated liver enzymes and eosinophilia of 700.

Which of the following steps is correct in managing this patient?

A 4-year-old boy is evaluated for repeat dyspnea episodes, abdominal pain, vomiting, and diarrhea. He has swelling and non-pitting edema around his ankles. There is no erythema, rash, or systemic fever. These episodes last for 2-3 days and spontaneously resolve.

Which of the following is the most appropriate treatment?

A 16-year-old male was referred due to suspected immunodeficiency after two episodes of Neisseria meningitidis meningitis, with no additional infections. Development, physical examination, and immunoglobulin levels are normal.

Which of the following tests will promote diagnosis?

A 2-year-old male was referred for workup of failure to thrive and recurrent respiratory infections. Complete blood count including differential are normal. All types of immunoglobulins are low, there are low immunoglobulins in response to vaccination, and CD19 levels are <1% of lymphocyte count. Sweat test is normal.

Which of the following is typical in the toddler’s most likely diagnosis?

A 16-year-old girl presents with facial swelling and shortness of breath which appeared the same morning, and had become worse over the last hours. Her history is positive for a few events of facial swelling that resolved spontaneously. Examination reveals findings in the attached pictures, heart rate of 125/min, respiratory rate of 25 breaths/min, blood pressure 110/75, saturation of 96% in room air, and non-pitting edema of the face, tongue, oral mucosa, and larynx.

Which of the following is the most likely finding in her blood work?

A 5-year-old girl arrives for evaluation due to an enlarged cervical lymph node she has had for the past 7 months. A neck US demonstrates no signs of malignancy; there have been recurrent incidents of enlarged lymph nodes in the past, and she is known to suffer from anemia that does not respond to treatment with iron. On physical examinations over the years, there is evidence of an enlarged liver and spleen.

Blood tests are as described in the table:

Which of the following complications is likely to occur in her condition?

A 1-year-old boy that for the past two months has had recurring events of high-grade fever accompanied by abdominal pains, vomiting and diarrhea. The episodes last about 5 days. The parents are healthy, born in Finland. The child has come in now with another episode. Physical examination: lymph nodes enlargement and also the findings described in the photos (please refer to the finding in the first photo even though the leg does not belong to a 1-year-old boy).

What is the most likely diagnosis?

A 1-year-old boy with recurrent pneumonia due to Streptococcus Pneumonia infection. Underlying atopic dermatitis, significant hemorrhage following circumcision and also several dermal infections. The collected blood tests are described in the table below:

What is the most reasonable recommended treatment in this case?

An 18-month-old boy, history of several otitis events, diarrhea due to Cryptosporidium infection and skin warts (verruca vulgaris). Investigation found a normal number of B cells, normal number of T cells, and a normal lymphocyte reaction to mitogen, but a low number of B CD27 cells.
Which of the following tests will most likely promote his diagnosis?

A 3-year-old male is under follow-up due to ataxic gait, two prior pneumonias, and abnormal eye findings (image attached).

Which test should be avoided during further evaluation?