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SINGAPORE – When Ashton Leow had diarrhoea, vomiting and fever on a Thursday in October 2021, a doctor gave the toddler some medicine for stomach flu.
By Sunday morning, however, the usually lively and energetic boy, then aged two years and four months, just wanted to lie on the couch.
His mother, Ms Claire Teo, noticed a reddish-blue spot on his right palm and another on his right leg. Ms Teo’s sister, a general practitioner, advised her to take him to the hospital because the spots looked very unusual.
Ashton’s parents consulted his paediatrician at a private hospital but were not overly worried about the boy, who is their third son.
“Our intention was to get him an IV (intravenous) drip because his lips were dehydrated, and he couldn’t keep anything down,” said his father, Mr Richard Leow, a director at a bank.
But it was not that simple. The team at the hospital found Ashton’s blood pressure to be very low, and his heart rate very high, said Ms Teo. More spots were appearing, including on his face, she said.
An ambulance was arranged to take Ashton to KK Women’s and Children’s Hospital (KKH), which has a paediatric intensive care unit (ICU). He would not leave KKH for 1½ months.
At KKH’s children’s emergency department, the doctors suspected that he had severe sepsis, and sent him to the ICU.
As it was during the Covid-19 pandemic, only one parent could be with the boy. Inside the ICU with the doctors, Ms Teo saw how baffled they were. “We had thought it was just stomach flu. But over the next 24 to 48 hours, all I kept getting was bad news, one after another. It has gone into the brain, into the bone.”
It turned out Ashton had a difficult-to-treat bacterial infection in his blood, skin, bones (osteomyelitis) and the lining of his brain (meningitis). A team from infectious diseases was called in to treat him.
Dr Bianca Chan, a consultant in KKH’s rheumatology and immunology service, said the ICU team suspected an immunodeficiency and referred the boy early for an immunology evaluation.
The initial screening suggested he might have X-linked Agammaglobulinemia (XLA or Bruton’s Agammaglobulinemia), where the body is unable to produce the antibodies to fight infections.
The condition is caused by a rare mutation in a gene that is required for the normal functioning of antibody-producing B-cells in the immune system.