CASE 6
Jason, a 6-year-old boy who lives on a farm, has convinced his parents that he should be allowed to take care of the chicks that are in the hay loft area of the barn. He is intrigued with this brood of chicks and spends hours just lying down in the hay to watch them or dragging hay over to their nest. When he is not in the barn, Jason is “helping” his mother with the new garden. After several weeks of this regimen, Jason started having difficulty breathing and seemed to “always be coughing.” The parents took him to their family physician, who had already treated Jason for a severe diaper rash (Candida albicans) when he was an infant and over the past few years for numerous severe bacterial infections.
The physician ordered several tests, including a complete blood cell count and differential, total serum immunoglobulins, immunization antigen titer, T cell function test, and a bronchoalveolar lavage to use for culture. The white blood cell count showed a mild leukocytosis, but the differential indicated a normal percentage of each cell type. Total IgG was normal for the pediatric population (see Appendix), as was the antibody titer to immunization antigens. T cell function was normal. An inquiry into Jason’s family revealed that he had three older sisters and two brothers, none of whom had presented with clinical symptoms analogous to those for which Jason’s parents had sought medical attention. How would you proceed?
QUESTIONS FOR GROUP DISCUSSION
RECOMMENDED APPROACH
Implications/Results of Laboratory Investigation
Laboratory tests revealed a mild elevation in white blood cell count, normal differential, normal serum immunoglobulins, and normal B cell and T cell function tests. These tests rule out obvious B cell and T cell development disorders (see Cases 2 and 3
