A 3-Year-Old Girl Is Evaluated for Hoarseness That Has Been

A 3-year-old girl is evaluated for hoarseness that has been getting worse over the past 2 months.  The patient has had no fever, shortness of breath, or change in activity level.  She is eating normally, gaining weight well, and does not seem to be in pain.  Vital signs are within normal limits.  On physical examination, the ears are normal appearing with no middle ear fluid.  The nasal mucosa is clear with no rhinorrhea, and the turbinates are normal in size.  There are no oral mucosal lesions.  The tonsils are small and nonobstructive.  There is no cervical lymphadenopathy.  Aside from hoarseness, examination of cranial nerves is normal.  Flexible laryngoscopy shows several finger-shaped lesions on both vocal cords.  Which of the following is the most likely cause of this patient's current condition?

A) Anomalous airway development
B) IgE-mediated hypersensitivity reaction
C) Inherited deficiency of C1 inhibitor
D) Maternally transmitted viral infection
E) Vaccine-preventable bacterial infection

Correct Answer:

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