A 26-Year-Old Man with a 5-Year History of Asthma Comes

question 157

Multiple Choice

A 26-year-old man with a 5-year history of asthma comes to the office for follow-up after a recent hospital discharge.  The patient was admitted due to fever, shortness of breath, trace hemoptysis, and productive cough with brownish mucus; he was treated with oral glucocorticoids, antibiotics, and nebulized bronchodilators.  There were 2 similar episodes in the past year which were treated in the emergency department with tapering oral glucocorticoids on each occasion.  He has a history of "walking pneumonia."  Current medications include fluticasone/salmeterol, montelukast, and as-needed albuterol.  He does not smoke cigarettes.  His father was a heavy drinker and died from liver cirrhosis.  The patient is not in acute distress.  Physical examination shows diffuse wheezing with adequate air entry.  A high resolution CT scan shows central bronchiectasis and a right lower lobe infiltrate.  Review of prior chest x-rays shows a lingular infiltrate and a left lower lobe infiltrate.  Which of the following is the most likely cause of this patient's symptoms?

• A)Autoimmune syndrome
• B)Deficiency in chloride transport
• C)Exaggerated IgG and IgE immune response to an antigen
• D)Immunodeficiency syndrome
• E)Protein deficiency allowing unrestricted action of a proteolytic enzyme