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Streptococcus pneumoniae is a common pathogen responsible for pulmonary infections and the leading cause of mortality and morbidity in patients with particularly B cell immunodeficiencies. Antibody production is the principal protective immune response against S. pneumoniae and measurement of the production of antipolysaccharide antibodies is important in the evaluation of B cell deficiencies. We quantified serotype-specific immunoglobulin G antibodies against seven common pneumococcal serotypes before and three weeks after unconjugated vaccine in 416 patients with recurrent respiratory tract infections; fifty-five (13%) of whom showed impaired antibody response. We could evaluate 41 of these 55 patients for their particular clinical features. Specific antibody deficiency, was diagnosed in 10 of these patients, common variable immunodeficiency in 18, ataxia telangiectasia in 10 and other antibody deficiencies in 7 (transient hypogammaglobulinemia in 4, IgG subclass deficiency in 1, partial and selective IgA deficiency in 1) patients. Evaluation of the antibody response to polysaccharide antigens should be considered early on in patients with recurrent respiratory infections and required particularly for the diagnosis of specific antibody deficiency and the decision of the appropriate treatment approaches.

Henoch Schönlein purpura (HSP) with acute rheumatic fever (ARF) is a rare entity and only few cases have been reported so far. In all previously reported cases with HSP and ARF, patients initially presented with purpuric rash, arthralgia/arthritis, or abdominal pain and later diagnosed as ARF. We report an 11-year-old girl with features of both ARF and HSP. She initially presented with arthralgia and murmur. Echocardiography showed mild to moderate mitral regurgitation. Later, the clinical course was complicated by purpuric rash and abdominal pain. She was treated conservatively with IM penicillin, acetylsalicylic acid and oral prednisolone. Our patient is the first patient with HSP and ARF who initially presented with features of ARF. A review of literature revealed a limited number of cases of HSP associated with ARF (14 cases including the present case); and that the response to treatment in cases suffering from ARF associated with HSP was good; but one should also be aware of serious cardiac complications in HSP patients which may be fatal.

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