Absence of the Thymic Shadow in a Neonate Suspected of Primary Immunodeficiency: Not a Straightforward Clinical Sign ofImmunodeficiency
Andrew S. Nickels, Thomas Boyce, Avni Joshi, John Hagan
DOI:
http://dx.doi.org/10.1016/j.jpeds.2014.08.068 Abstract
A 33-week-old male presented with respiratory distress and fever after birth to a mother experiencing an acute diarrheal illness. Evaluation of the infant revealedCampylobacter jejunibacteremia. The newborn screen, collected at 30 hours of life, was positive for severe combined immunodeficiency (SCID). A chest radiograph on day 9 demonstrated an absence of the thymic shadow (Figure1). Investigation of the immune system revealed normal TBNK cell subsets, CD4 recent thymic emigrants, and T-cell receptor excision circles, suggesting the newborn screen was a false positive.
