A 2-year-old girl has experienced frequent infections from early infancy, including repeated chest infections, UTIs and ear infections. She developed asthma at age 13 months and has needed oral prednisolone on several occasions. What further tests does the patient need and what can be done to prevent her repeated chest infections?
Lilly, now aged 2 years, has had frequent respiratory and urinary tract infections (UTIs) for most of her life. At 5 weeks of age, she was hospitalised with bronchiolitis. Between 3 and 5 months of age, she was frequently taken to her GP with repeated chest infections. Between 6 and 9 months of age, she had multiple UTIs and was given trimethoprim prophylaxis. Subsequent kidney function tests showed no structural abnormalities, and she was taken off the prophylaxis. At 10 months of age, she was hospitalised with gastroenteritis and needed IV rehydration. At 13 months of age, three courses of antibiotics failed to clear a chest infection, resulting in her being hospitalised with pneumonia. Following this, she developed asthmatic symptoms and was prescribed an inhaled corticosteroid (beclometasone 100 mcg twice daily) plus salbutamol as needed. An isolated immunoglobulin A (IgA) deficiency test was positive.