# A nurse is assessing a 35-year-old patient who has been experiencing recurrent infections over the past 6 months. Which assessment finding would be most indicative of a primary immunodeficiency disorder? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540861 > language: ko > subject: Adult Health ## 문제 A nurse is assessing a 35-year-old patient who has been experiencing recurrent infections over the past 6 months. Which assessment finding would be most indicative of a primary immunodeficiency disorder? ## 보기 1. Presence of enlarged lymph nodes and spleen since early childhood 2. History of recent travel to endemic areas for infections 3. Recurrent severe infections with opportunistic organisms since early childhood **✔ 정답** 4. Elevated white blood cell count with left shift on labs **정답: 3** ## 해설 Recurrent severe infections with opportunistic organisms since early childhood is the hallmark of primary immunodeficiency, indicating a congenital defect. Other findings (e.g., enlarged lymph nodes, travel history) are less specific or suggest secondary causes. ## 심화 해설 Understanding Primary Immunodeficiency Disorders When a young adult presents with a history of recurrent infections, the nurse must differentiate between secondary causes of immunosuppression and a primary immunodeficiency disorder (PID). PIDs are intrinsic defects in the immune system, often genetic, that lead to an increased susceptibility to infections. The key to identifying a PID lies in the pattern, severity, and age of onset of the infections. The provided rationale highlights that Common Variable Immunodeficiency (CVID), the most frequent symptomatic PID in adults, is characterized by recurrent infections and can lead to complications like unexplained bronchiectasis [1]. Analysis of the Correct Answer (Option 3) The finding most indicative of a primary immunodeficiency is "Recurrent severe infections with opportunistic organisms since early childhood." This presentation is a hallmark of a significant, intrinsic immune defect. A healthy immune system can typically contain opportunistic organisms, which are microbes that rarely cause disease in an immunocompetent host. The fact that these infections are severe, recurrent, and date back to early childhood points directly to a congenital or inherent problem in the immune system's development or function. This pattern is consistent with disorders like STAT3 hyper IgE syndrome (STAT3-HIES), a rare inborn error of immunity where patients suffer from recurrent bacterial and fungal infections from a young age [3]. The chronicity and early onset are critical clues that distinguish a PID from a transient or acquired immune issue. Why the Other Options Are Less Indicative - Option 1: Enlarged lymph nodes and spleen since early childhood can be associated with certain PIDs, but this finding is not specific. It can also be a feature of chronic infections, autoimmune disorders, or hematologic malignancies. While it warrants investigation, the direct history of severe, opportunistic infections is a more definitive and functionally significant indicator of an immune system failure. - Option 2: A history of recent travel to endemic areas is a classic risk factor for a secondary infection in an otherwise healthy individual. It points to an external exposure event rather than an intrinsic immune defect. This history would be more relevant for diagnosing a specific travel-related illness, not a PID. - Option 4: An elevated white blood cell count with a left shift is a typical laboratory finding in an acute bacterial infection, representing the body's normal, reactive response to a pathogen. It indicates that the innate immune system is mobilizing neutrophils to fight an infection. While a patient with a PID can develop this lab finding during an acute infectious episode, the lab value itself is a marker of the response, not the underlying chronic immunodeficiency. A PID is more often suspected when the clinical history of infections is disproportionate or caused by unusual organisms, regardless of the acute white blood cell response. The diagnostic journey for a young adult with recurrent infections should always prompt an evaluation for a primary immunodeficiency, as early recognition and appropriate therapy, such as immunoglobulin replacement for CVID, can significantly improve outcomes [1]. The clinical history of infection type, severity, and onset remains the most powerful tool in raising suspicion for these disorders.References (research sources) - [1]The diagnostic journey of a young adult with recurrent infections and progressive dyspnoea.Research articleVenugopal V, Karmakar S, Singh GK, Maji D, Srivastava A, Soni JR. (2026) · DOI: 10.1183/20734735.0330-2025 - [3]How I Treat: STAT3 hyper IgE syndrome.Research articleMurray CE, Jannoud E, Prader S, Grimbacher B. (2026) · DOI: 10.70962/jhi.20260038 ## 임상 시나리오 Clinical Guide: Identifying Primary ImmunodeficiencyKey assessment findings to differentiate PID from secondary causes Suspect a primary immunodeficiency disorder (PID) when a patient presents with a history of recurrent, severe infections beginning in early childhood. A hallmark is infection with opportunistic organisms (e.g., Pneumocystis jirovecii, Candida albicans) that rarely cause disease in an immunocompetent host. The most common symptomatic PID in adults is Common Variable Immunodeficiency (CVID). Look for recurrent sinopulmonary infections and unexplained bronchiectasis. In contrast, an elevated WBC with a left shift suggests a normal, acute response to infection, not an intrinsic defect. CautionDo not confuse PID with secondary immunodeficiency caused by HIV, chemotherapy, or malnutrition. A thorough history of infection onset, frequency, and pathogen type is critical for accurate triage and referral. ## 핵심 개념 - **Primary Immunodeficiency Disorder (PID)** — An intrinsic, often genetic, defect in the immune system leading to increased susceptibility to infections, typically presenting in early childhood. - **Opportunistic Organisms** — Microbes that rarely cause disease in a person with a healthy immune system but can cause severe illness in an immunocompromised host. - **Common Variable Immunodeficiency (CVID)** — The most common symptomatic primary immunodeficiency in adults, characterized by low antibody levels and recurrent infections. - **Left Shift** — An increase in immature neutrophils (bands) in the blood, indicative of an acute bacterial infection and a normal bone marrow response. - **Secondary Immunodeficiency** — An acquired impairment of the immune system resulting from external factors such as infection (e.g., HIV), malnutrition, or medications. ## 같은 주제 문제 - [A nurse is assessing a 28-year-old patient who has been experiencing recurrent infections …](https://mymerci.kr/pages/nclex_q.php?qn_id=540860) - [A nurse is assessing a 28-year-old patient with suspected primary immunodeficiency syndrom…](https://mymerci.kr/pages/nclex_q.php?qn_id=540862) - [A nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) who has deve…](https://mymerci.kr/pages/nclex_q.php?qn_id=540863) - [A nurse is caring for a 38-year-old female client with acquired immunodeficiency syndrome …](https://mymerci.kr/pages/nclex_q.php?qn_id=540864) - [A nurse is caring for a 45-year-old male client with acquired immunodeficiency syndrome (A…](https://mymerci.kr/pages/nclex_q.php?qn_id=540865) - [A nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) who has a CD…](https://mymerci.kr/pages/nclex_q.php?qn_id=540866) - [A nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) who has a CD…](https://mymerci.kr/pages/nclex_q.php?qn_id=540867) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._