09-22-2007, 09:31 AM
A 42-year-old man has lost 7 kg over the past two years. During that time he has had pain and swelling around the small joints of his hands and feet. He has had a series of upper respiratory tract infections, with organisms including Staphylococcus aureus, Streptococcus pneumoniae, and Pseudomonas aeruginosa cultured. He has a chronic diarrhea. A stool specimen is found to have Giardia lamblia cysts. Laboratory studies show a hemoglobin of 8.8 g/dL with a reticulocyte count of 3.2%. His serum urea nitrogen is 19 mg/dL with creatinine 1.0 mg/dL. His antinuclear antibody test is negative. Quantitative serum immunoglobulins show IgA 70 mg/dL, IgG 303 mg/dL, and IgM 64 mg/dL. By flow cytometry there are normal numbers of T cells and slightly reduced numbers of B cells. Which of the following conditions is most likely to be present in this man?
A HIV infection
B Polymyositis
C Bruton agammaglobulinemia
D Common variable immunodeficiency
E Diabetes mellitus
A HIV infection
B Polymyositis
C Bruton agammaglobulinemia
D Common variable immunodeficiency
E Diabetes mellitus