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ROBERT E. FECHNER
Arch Otolaryngol. 1981;107(1):66-69. doi:10.1001/archotol.1981.00790370068016.
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PATHOLOGIC QUIZ CASE 1 

Richard W. Waguespack, MD, Galveston, Tex  A 4-year-old boy had severe combined immunodeficiency and adenosine deaminase deficiency that had been diagnosed at 2 months of age.1,2 The patient had spent most of his life in protective isolation but had had multiple infections including Nocardia pneumonia, Pneumocystis carinii pneumonia (three episodes), malabsorption, oral and perineal candidiasis, and myobacterial osteomyelitis of the left arm. The latter resulted in his receiving antituberculous therapy until July 1978, when its use was discontinued because hepatitis had developed. The child has been treated with thymosin for his primary disease. He initially was seen in August 1978 by our otolaryngology service for clear rhinorrhea, but the examination's results were unremarkable. He remained hospitalized, having several episodes of fever of an undetermined cause, and he was seen again on Dec 21, 1978, for right periorbital swelling and fever.The examination at this time indicated

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