Dr Spur's mystery case : a mystery case as old as time

Abstract

Dear Dr Spur I would appreciate your advice on a complicated patient. This is a 21-year-old female who has suffered from eczema since childhood. The eczema used to be very severe during childhood, but is presently more manageable with occasional flares. She currently has an axillary abscess, which is a painful, fluctuating mass under her left arm. She has had more than 20 abscesses over the past decade. She has had multiple episodes of pneumonia since childhood (at least > 10 episodes) and had a left lower lobectomy at 18 months of age. She fractured her arm following minor trauma several years ago. She also suffers from recurrent episodes of Candida nail infections. She has had several teeth removed and has had recurrent dental infections. She also said that some of her primary teeth did not erupt. On allergy testing, she appears to be allergic to everything! Her allergen specific IgE levels were positive for all the inhalants and food tested. Please advise on further investigation and management.