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Case history:

A 7yrs old boy from related parents,He presented by apthus,stomatitis,persistent thrush in infancy and Candidal nail infection in early childhood just one nail.He has hearing loss.

Recurrent problems since 1yrs ago: fever and weakness.

CBC was done.Due to anemia , leukocytosis  and hypereosinophila  was admitted to hospital  and workup for  hypereosinophlic syndrome was done:

WBC :  15/200, [  POLy : 59%, Lym: 6% , Eos : 35%] , Hb : 10/4 mg /dl Plt: 348000               ESR: 90  

Wright , Widal, serologic assay for Toxa cara and toxo canis  were negative.Cholestrol , TG , ferritin level  were normal

 Abdominal sonography  ,CT scan report:

Multiple hypodense  lesion with hyperdense center in liver , multiple enlarged lymph node with necrotic hypodense center in retroperitoneal and periartoa ( largest 35 mm) suggestive lymphma , BCGosis.Workup was done for rule out these diseases; Gastric washing (3times ) was negative.LDH , ferritin level were in normal limits.BMA and BMB ruled out malignancy.In Laparatomy multiple lymph node in intraabdominal and retroperitoneal was seen.Pathology reported Necrotizing granulomatosis inflammation. PAS staining was positive for fungal elements and negative for AFB.Galactomaman was 0/75.(Positive > 0/5)Then started longterm antifungual fore patient.Immunology worke up include:Ig level,flocytometry and NBT was normal range. and HIV PCR was negative.

 Lymphocyte transformation test(LTT):response to candida was  low.

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