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Pediatrics · Genetic and metabolic disorders: leukocyte adhesion deficiency
Sample itemAn infant has delayed umbilical cord separation at 5 weeks, omphalitis and recurrent skin infections without pus formation. The blood count shows marked neutrophilia. What is the likely diagnosis?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Leukocyte adhesion deficiency type 1
Leukocyte adhesion deficiency type 1, from CD18 integrin deficiency, prevents neutrophils from leaving blood vessels, so the cord separates late, infections occur without pus and neutrophil counts are very high. Bone marrow transplantation can cure it. In chronic granulomatous disease neutrophils reach the site but cannot kill.
Option by option
A. Cyclic neutropenia
Cyclic neutropenia gives periodic low neutrophil counts, not neutrophilia.
B. Chronic granulomatous disease
Chronic granulomatous disease forms granulomas and abscesses and has normal cord separation.
C. Severe combined immunodeficiency
Severe combined immunodeficiency shows lymphopenia rather than neutrophilia.
D. Leukocyte adhesion deficiency type 1 (correct)
Correct. Late cord separation with neutrophilia and pus-free infections indicates CD18 deficiency.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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