From Eudowood Division of Immunology, Department of Pediatrics, The Johns Hopkins Hospital, Baltimore, Md.
Grand Rounds at The Johns Hopkins Hospital section editors: David
B. Hellmann, MD, D. William Schlott, MD, Stephen D. Sisson, MD, The Johns
Hopkins Hospital, Baltimore, Md; Edie Stern, managing editor, The Johns Hopkins
Hospital; David S. Cooper, MD, Contributing Editor, JAMA .
A 35-year-old woman with pneumococcal bacteremic pneumonia was admitted
to her local hospital in 1986. Her initial hospital course was complicated
by respiratory insufficiency, disseminated intravascular coagulation, and
renal failure, and she was transferred to The Johns Hopkins Hospital for further
evaluation and management.
Her medical history was notable for multiple episodes of bronchitis
and otitis media in childhood, and a tonsillectomy and adenoidectomy at age
16 years. At age 29 years, she began to experience multiple episodes of sinusitis,
a chronic productive cough, and frequent diarrhea. She also had 2 episodes
of pneumonia; one, at age 33 years, required hospitalization for intravenous
antibiotics to treat Streptococcus pneumoniae, which
had been isolated from a sputum culture. During the year preceding her 1986
admission, she developed dyspnea on exertion and intermittent diarrhea and
lost 13.5 kg. She had to quit her job and could no longer do her routine housework.
Sicherer SH, Winkelstein JA. Primary Immunodeficiency Diseases in Adults. JAMA. 1998;279(1):58-61. doi:10.1001/jama.279.1.58