A 27-year-old man with recurrent sinopulmonary and cutaneous infections

Abstract

The increasing availability of genetic testing for modern immunologists in the evaluation of immune diseases could provide a definite diagnosis in elusive cases. A 27-year-old white male patient presented to the clinic with recurrent sinopulmonary and cutaneous infections since childhood. The patient’s mother had seronegative polyarthritis, and one of two sisters of the patient had chronic sinopulmonary infections. Serum immunoglobulins, immunoglobulin G (IgG) subclasses, lymphocyte subset markers, mannose-binding lectin, mitogen and antigen stimulation, bacteriophage study, and Streptococcus pneumoniae titers to 23 serotypes were all normal. B-cell phenotyping revealed a decrease in both nonswitched memory B cells (CD19+CD27+IgD+) and switched memory B-cells (CD19+CD27+IgD−). Genetic testing and the improvement of clinical symptoms after IgG replacement led to the final diagnosis.

The Second Generation Perspective to My Medical Conspiracy

“…Marija is finding her own academic success, including presenting and publishing in varying topics, included those highlighting the osteopathic perspective. [12][13][14][15][16][17][18][19][20][21][22][23][24]27 She superseded her father, who did not presented a poster until his fifth year as a pre-doctoral OMM fellowship and would not publish until all formal training was completed. 25,26 It is wonderful to see the next generation move light years ahead.…”

The continuing “1000 faces of asthma”

“…The purpose of the POPS series is to provide an innovative and practical learning experience for the allergist/immunologist in-training by using a didactic format of clinical presentation and deductive reasoning. In this issue's POPS, Wu et al 39 from University Hospitals Cleveland Medical Center lead the reader through this learning process, illustrating the complexity of the differential diagnostic process for this clinical presentation and the importance of a detailed history, physical examination, and appropriate laboratory assessment in arriving at a correct diagnosis. 39 In summary, the collection of articles found within the pages of this issue provides further insight into the intersecting crossroads of genetics and the environment that manifest as the allergic, cutaneous, and respiratory disorders that afflict patients served by the allergist/immunologist.…”

“…In this issue's POPS, Wu et al 39 from University Hospitals Cleveland Medical Center lead the reader through this learning process, illustrating the complexity of the differential diagnostic process for this clinical presentation and the importance of a detailed history, physical examination, and appropriate laboratory assessment in arriving at a correct diagnosis. 39 In summary, the collection of articles found within the pages of this issue provides further insight into the intersecting crossroads of genetics and the environment that manifest as the allergic, cutaneous, and respiratory disorders that afflict patients served by the allergist/immunologist. In particular, these articles exemplify how the complexities of asthma, allergic rhinitis, CU, HAE, immunodeficiency, and food allergy continue to challenge the allergist/immunologist.…”