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Grand Rounds
January 7, 1998

Primary Immunodeficiency Diseases in Adults

Author Affiliations

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 .

JAMA. 1998;279(1):58-61. doi:10.1001/jama.279.1.58

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.