Dr Spur’s mystery case : a case of fragile defences

Abstract

I am treating a ten-month-old boy diagnosed with di George syndrome. He has a history of failure to thrive, which was mostly attributed to his cardiac anomalies (more specifically, a ventricular septal defect which has since been repaired). I am concerned about his infection history. Over the past four months he has experienced multiple episodes of upper respiratory tract infections characterised by nasal congestion, clear to mucopurulent rhinorrhoea, intermittent low-grade fever, cough (initially dry, progressing to a productive cough with occasional wheezing), feeding dif昀椀culties and refusal of feeds during episodes. He does not have any palatal anomalies. Despite symptomatic treatment with nasal saline irrigation, antipyretics and antibiotics on at least two occasions, the symptoms would resolve slowly over 10–14 days, only to recur within another week or two. Between infections, he never seems to return to baseline, exhibiting a persistent nasal discharge and a ‘wheezy chest’.