一位 2 歲大的男童，自出生 6 個月後反覆有中耳炎、細菌性鼻竇炎及肺炎，雖然施打卡
介苗，直至目前並無任何關於卡介苗的併發症，除了一般常規的 CBC/DC 檢查之外，你認
為下列何種檢測最能出病因？
(A)Lymphocyte proliferation test including antigens and mitogens
stimulation
(B)Immunoglobulins level（IgG, A, M, E）& lymphocyte subsets
(C)PMN function tests, including chemotaxis, nitroblue tetrazolium test, CD
11 /CD 18 expression及phagocytosis
(D)HIV 1+2 Ab
答案: B
建議答案: B或C
申覆理由:
根據Nelson Textbook of Pediatrics, 18th Ed
在任何病人可能有recurrent or unusual pneumonia, lymphadenitis, hepatic or
other abscesses, osteomyelitis at multiple sites, 都應該懷疑chronic
granulomatous disease(CAG). 且CAG臨床徵狀為各式各樣的. 此病可以從early
infancy to young adulthood. 另外Leukocyte adhesion deficiency(LAD)的臨床表現也
可能為recurrent, indolent bacterial infections of the skin, mouth,
respiratory tract, lower intestinal tract, and genital mucosa.故此病人在無法排
除CAG和LAD的可能時, 也應安排nitroblue tetrazolium test, CD 11 /CD 18
expression的檢查. 故此題建議答案為B或C.
參考資料：
Nelson Textbook of Pediatrics, 18th Ed
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