A 4-Year-Old Boy Is Brought to the Office for Difficulty

A 4-year-old boy is brought to the office for difficulty breathing through his nose.  The issue started 6 months ago and has progressively worsened.  Since his adoption at age 6 months, the patient has had recurrent epistaxis and numerous courses of antibiotics for sinus infections and pneumonia.  Weight and height are at the 3rd and 5th percentiles, respectively.  Temperature is 38.9 C (102 F) , blood pressure is 100/70 mm Hg, pulse is 112/min, and respirations are 24/min.  Pulse oximetry reveals an oxygen saturation of 93%.  Physical examination shows a thin boy with audible nasal breathing and bilateral nasal polyps.  The oropharynx is clear, and the neck is supple.  Cardiac examination is unremarkable.  Lung auscultation reveals diffuse, coarse crackles.  The abdomen is soft with no organomegaly.  Pulses are strong, and digital clubbing is present.  Which of the following is the most likely diagnosis in this patient?

A) Cystic fibrosis
B) Eosinophilic granulomatosis with polyangiitis
C) IgA deficiency
D) Severe allergic rhinitis
E) Severe combined immunodeficiency

Correct Answer:

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