Answer to the last #DiagnosticDilemma
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The answer to the last Diagnostic Dilemma (A 12-year-old boy with recurrent infections) is Chronic Granulomatous Disease .

A 12-year-old boy was admitted to the hospital because of fever, chills, sweats, productive cough, nausea, and vomiting. He had been subject to recurrent pneumonias since the age of 5 years. On physical examination, he was febrile, tachycardic, and tachypneic; diffuse rhonchi were heard in both lungs. The patient also had finger clubbing, splenomegaly, and massive lymphadenopathy in the cervical, axillary, and preauricular areas and the epitrochlear and inguinal areas of his body.

Blood cultures grew Staphylococcus aureus. A chest radiograph and computed tomography of the chest revealed multiple bilateral abscesses in both lungs. The results of a nitroblue tetrazolium reduction test and immunoblotting suggested a diagnosis of chronic granulomatous disease, which is characterized by recurrent life-threatening bacterial and fungal infections and granuloma formation. Most patients receive a diagnosis before reaching 5 years of age.

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Source: NEJM
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