A few months ago, I wrote about a patient who had been told by several of her clinicians that her medical concerns were based on anxiety and depression. Back then, after listening to her history, especially with multiple hospitalizations for pneumonia, I decided to work her up for an immunoglobulin deficiency. I can now report the patient had absolutely no response to the pneumococcal challenge.
As you can imagine, the patient is extremely frustrated, and she has every right to be. She believes that she may have been listened to, but wasn’t heard. There are many out there that would have classified her with Whiny White Woman Syndrome, and in her case that could have been a huge mistake.
What makes matters worse is that I ran this presentation by a now fourth year medical student and he automatically said the patient needed to be worked up for an immunoglobulin infection. Mind you, he’s studying for his boards but still, any adult with more than two bacterial pneumonias should have an immunological workup. In this case it may have been because the patient’s IgG and subclasses were all within a normal range. This can occur. This is why you do the pneumococcal challenge to see if there is immunological dysfunction. The patient’s official diagnosis now is Antibody Specific Immunoglobulin Deficiency.
Recurrent bacterial infections is not a joke. This is how antibiotic resistance comes about. In addition, chronic or recurrent infections are also very fatiguing. This patient in particular has been complaining of severe fatigue for years.
The patient has also been found to have obstructive sleep apnea (OSA) and a CPAP has been ordered for her. The OSA may also be a contributing factor to the patient’s refractory GERD. I have written several times how both OSA and GERD are both contributing factors to recurrent or chronic sinusitis.
Patients with OSA usually complain of chronic fatigue, which makes sense. There’s nothing better than a good night’s sleep and if you’re having disrupted sleep because of OSA you will be fatigued.
In conclusion this patient has gone from being diagnosed with anxiety and depression to having an immunoglobulin deficiency and OSA. The sad thing is how many more like her are out there?
