WBR0470

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Immunology
Sub Category	SubCategory::Hematology
Prompt	[[Prompt::A 10 year old boy is brought his mother to the physician's office because his mother says he looks different from his siblings. On physical examination, the physician notes abscesses, retained primary teeth, and eczema. Which of the following lab findings are most consistent with the patient's symptoms?]]
Answer A	AnswerA::Low IgE levels
Answer A Explanation	AnswerAExp::Job's syndrome is characterized by hyper IgE levels, not low IgE levels.
Answer B	AnswerB::Elevated IgE levels
Answer B Explanation	AnswerBExp::Elevated IgE level is seen in hyper-IgE syndrome.
Answer C	AnswerC::Elevated IgG levels
Answer C Explanation	AnswerCExp::Elevated IgG levels are seen following re-exposure to an antigen. Monocloncal IgG gammopathy may mean multiple myeloma.
Answer D	AnswerD::Elevated IgA levels
Answer D Explanation	AnswerDExp::Monoclonal elevation of IgA levels may be seen in multiple myeloma.
Answer E	AnswerE::Gradual lowering of all immunoglobulin levels
Answer E Explanation	AnswerEExp::Gradual lowering of levels of all immunoglobulin levels is not characteristic of Hyper-IgE syndrome. It is characteristic of Wiskott-Aldrich syndrome.
Right Answer	RightAnswer::B
Explanation	[[Explanation::Hyper-IgE syndrome (HIES) or Job's syndrome is a primary immunodeficiency caused by a selective deficiency of interferon-gamma synthesis. Signs and symptoms include: elevated IgE levels, atopic dermatitis (eczema), extracellular infections manifested by cold staphylococcal abscesses, with abnormal facies, fractures following minimal trauma and scoliosis, and retention of primary teeth. Educational Objective: Hyper-IgE syndrome is a primay immunodeficiency caused by a selective deficiency of interferon-gamma production that causes elevated IgE, coarse facial features, retained primary teeth, and cold staphylococcal abscesses. Reference: Minegishi Y. Hyper-IgE syndome. Curr Opin Immunol. 2009;21(5):487-492 Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::job's syndrome, WBRKeyword::job's, WBRKeyword::syndrome, WBRKeyword::IgE, WBRKeyword::hyper, WBRKeyword::coarse, WBRKeyword::facies, WBRKeyword::eczema, WBRKeyword::retained, WBRKeyword::primary, WBRKeyword::teeth, WBRKeyword::primary teeth, WBRKeyword::Buckley, WBRKeyword::hyperimmunoglobulin, WBRKeyword::HIES, WBRKeyword::abscess, WBRKeyword::staphylococcal
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::