The patient is a 4-year old boy who presented to the Emergency Department with shortness of
breath and persistent cough. Evidence of soft tissue infection with erythema and fluctuant lesion
in posterior neck fold was also observed. However, his temperature was normal (37.1°C) with no
signs of fever. No tachycardia or hypertension was noted.
He was immediately started on intravenous antibiotics (vancomycin 15mg/kg/8 hours,
piperacillin\\tazobactan 100 mg/kg/q8 hrs) and he is currently in stable condition and under
observation. The patient is otherwise alert and healthy.
The patient has a history of recurrent skin and lung infections (Staphylococcus aureus,
Pseudomonas aeruginosa, Streptococcus pneumonia) and has been treated numerous times with
antibiotics (ceftriaxone, vancomycin, piperacillin\\tazobactam). Ear tubes were placed at 2 years
of age for recurrent ear infections. No history of unusual viral or fungal diseases was noted.?
The patient is the only son of Ashkenazi Jewish immigrant parents from a small village in
Eastern Europe and may be distantly related due to consanguineous marriage of great-
grandparents.
The patient has received all of his normal childhood vaccinations, including DPT, MMR, HiB,
Pneumovax.
Do you expect this patient to be suffering from systemic infection? Is an immune response
occurring? What based on their presentation and past medical history led you to your answer?
Solution
Yes, there is an evidence of systemic infection. The past medical history reveals infection of
different body organs such as ears, lungs, skin. There is a strong evidence that the bacteria
causing these conditions lie in the bloodstream where from they migrate to these organs . It
seems that patient does not show normal immune response from the bacteria that has invaded
previously as there is recurrence of same lung problems again..
The patient is a 4-year old boy who presented to the Emergency Depar.pdf
1. The patient is a 4-year old boy who presented to the Emergency Department with shortness of
breath and persistent cough. Evidence of soft tissue infection with erythema and fluctuant lesion
in posterior neck fold was also observed. However, his temperature was normal (37.1°C) with no
signs of fever. No tachycardia or hypertension was noted.
He was immediately started on intravenous antibiotics (vancomycin 15mg/kg/8 hours,
piperacillintazobactan 100 mg/kg/q8 hrs) and he is currently in stable condition and under
observation. The patient is otherwise alert and healthy.
The patient has a history of recurrent skin and lung infections (Staphylococcus aureus,
Pseudomonas aeruginosa, Streptococcus pneumonia) and has been treated numerous times with
antibiotics (ceftriaxone, vancomycin, piperacillintazobactam). Ear tubes were placed at 2 years
of age for recurrent ear infections. No history of unusual viral or fungal diseases was noted.?
The patient is the only son of Ashkenazi Jewish immigrant parents from a small village in
Eastern Europe and may be distantly related due to consanguineous marriage of great-
grandparents.
The patient has received all of his normal childhood vaccinations, including DPT, MMR, HiB,
Pneumovax.
Do you expect this patient to be suffering from systemic infection? Is an immune response
occurring? What based on their presentation and past medical history led you to your answer?
Solution
Yes, there is an evidence of systemic infection. The past medical history reveals infection of
different body organs such as ears, lungs, skin. There is a strong evidence that the bacteria
causing these conditions lie in the bloodstream where from they migrate to these organs . It
seems that patient does not show normal immune response from the bacteria that has invaded
previously as there is recurrence of same lung problems again.
