Aliya Agassi, a 3-year-old girl with pneumonia, a temperature of 40.8°C, respirations 42 per minute (normal 20), and blood oxygen saturation of 90% (normal is more than 98%), was admitted to the hospital. Her neck and armpit lymph nodes were enlarged, and X-rays confirmed inflammation in the lower lobe of her right lung. Her medical history revealed two previous cases of pneumonia and six middle-ear infections that were treated successfully with antibiotics. A blood culture grew Haemophilus influenzae. Blood tests showed elevated levels of IgM above normal, whereas IgA and IgG were not detected. Her father had normal levels of serum IgA, IgG, and IgM. Which of the following is the most likely cause of her symptoms? a. acute lymphoblastic leukemia b. IgA deficiency c. X-linked agammaglobulinemia d. severe combined immunodeficiency e. X-linked hyper IgM syndrome f. AID deficiency g. myeloma.

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