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We would like to refer and discuss a 15-month-old boy who we believe has autoimmune neutropenia, in the context of recurrent infections and significant feeding difficulties.
He initially presented to us on February 2026 with acute food refusal, intermittent non-bilious vomiting, and parental concern regarding recurrent respiratory illnesses. Prior to this, he had a 3-week admission to B Children’s Hospital in December 2025 with COVID infection and tonsillitis. Since that admission, there has been a noticeable and persistent decline in his oral intake.
On initial assessment, he demonstrated ongoing feeding refusal with reliance on nasogastric feeding, alongside a background of recurrent viral illnesses.
Throughout his admission, he has undergone extensive investigation across multiple systems to evaluate both his feeding difficulties and recurrent infections. Please find attached the full reports and blood results.
1. Respiratory:
Extended respiratory PCR testing has identified multiple viral pathogens. On 31st March, he tested positive for RSV, human rhino/enterovirus, and adenovirus (please see attached results for full details).
2. Gastrointestinal:
- Barium swallow: normal
- Abdominal ultrasound: normal
- Faecal calprotectin: normal
- Faecal elastase: pending
He has been reviewed by the paediatric dietitian and is currently on a feeding plan via NG tube consisting of 5 feeds per day (165 ml per feed of Neocate). He is offered three meals and snacks; however, he continues to only take minimal amounts orally.
3. Immunology / Haematology:
He has demonstrated persistent but improving neutropenia, with counts fluctuating from 0.96 to a nadir of 0.21 (17th March), and most recently 0.86 (7th April).
Additional findings include:
- B12 >2000
- Tissue transglutaminase (TTG): negative
- Zinc level: 7.3 (low), for which he has been treated with zinc sulfate (2 mg/kg for 2.5 weeks, now reduced to 1 mg/kg, planned for a total 6-week course)
- Vaccine response testing has been sent and is pending
- Further pending investigations include copper, mannose-binding lectin (MBL), and faecal elastase
Baseline immunoglobulins and lymphocyte subsets are within normal limits.
Current management includes:
- NG feeding regimen as above
- Omeprazole
- Zinc supplementation
- Consideration of prophylactic azithromycin
- Ongoing dietetic input and support to transition to oral feeding
Given the combination of recurrent infections, suspected autoimmune neutropenia, and persistent feeding difficulties, we would greatly value your input regarding:
- Further evaluation and confirmation of autoimmune neutropenia or other underlying immunological disorder
- Interpretation of pending immune and micronutrient investigations, including vaccine responses
- Recommendations for ongoing management, including the role of prophylactic therapies
He remains under close review with regular weight monitoring and multidisciplinary input.
Please let us know if any further information would be helpful.
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