The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to recognize accurately. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a Case Challenge, please contact us.
A mother of three young children presents to a pediatrician's office with her oldest child due to concerns regarding an ear infection. Her son has had a fever to 102°F that began 2 days earlier. Copious purulent drainage from his left ear canal was noted today.
The patient is a 5-year-old male. A thorough review of his medical chart reveals repeated clinic visits for similar infections since age 1 year. He has been treated for recurrent bacterial pneumonia as an outpatient and twice required inpatient hospitalization. These lower respiratory tract infections were noted to affect the left, right, and bilateral pulmonary fields, at various times. Due to recurrent bacterial infections of the ears and lungs, pressure-equalizing (PE) ear tubes were placed and a referral was made to pediatric pulmonology to investigate the possibility of an anatomic cause for the recurrent pneumonias.
Despite these interventions, his infections have continued. Typically, he has required an antibiotic course to treat infections every 1 to 3 weeks. The longest stretch noted between treatment courses was 2 to 3 months.
The patient is up to date on his immunizations, including a completed pneumococcal vaccine series and annual influenza vaccinations. His two younger siblings, a brother aged 3 years and a sister aged 2 years (both born to the same parents), are healthy and well developed. His siblings reportedly do not have frequent or recurrent bacterial illnesses. Family history is also unremarkable.
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Cite this: Recurrent Infections in a 5-Year-Old Boy - Medscape - Jul 30, 2018.