We present a 6-year-old boy with recurrent sinopulmonary infections, decreased serum IgG levels, decreased memory and switched B cells, decreased antibody responses to Streptococcus pneumoniae immunization, diarrhea, and abdominal pain. Intravenous immunoglobulin was initiated, which resulted in marked improvement of infections. Plasma interleukin (IL)-6 and IL-8 levels were elevated, and subsequent endoscopy and small bowel radiographic studies revealed nodular lymphoid hyperplasia (NLH) affecting the ileum. The NLH was treated with enteric-coated budesonide, which dramatically improved the gastrointestinal symptoms, and the plasma IL-6 and IL-8 became undetectable.
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