Dear sir 2young couple, closely relative to each have a big problem .They have 6 children 3 alive & 3 died due to unknown cause. Those who died usually the problem started at the age 4-6month as chest infection which is resistant to treatment.Those who died are male & female. The 1st died at 4m, 2nd died at 6m, 3rd died at 2year after a protracted course of illness started as LRT infection & lymphadenopathy . The age of the alive children are 8y (female) , 3y(female), 18m(male).The 1st & 3rd are totally normal.The 2nd child is 3y(female) run the same illness LRT infection , lymphadenopathy, FTT progress to chronic lung disease + clubbing of fingure+ chronic exuding ,fascial widespreading skin infection . Those who died & this pt. are fully vaccinated ,while those survived are not vaccinated . On exam. Chronically ill child under weight dyspenic with + clubbing of fingure Vital sign are normal apart from tachypenia Generalized lymphadenopathy, Resp. system: bilatrel rhonchi & crepition Cvs. System: normal Soft abdomen, mild hepatosplenomegaly Investigation: Cbc normal GOT+GPT normal Blood urea & creatinin normal Immunoglobuline assay normal ESR 50 Sweat test normal Toxoplasmosis titer: -ve Blood , urine, stool culture are –ve Tt reaction –ve ACE normal Sputum for Tb bacilli –ve Gastric aspirate for Tb bacilli –ve Bone scan normal Abdominal sonar normal Cxr & CAT scan chest infection & hilar lymphadenopathy +lung fibrosis. Lymph node & lung biopsy :Follcular hyperplastic lymphadenitis with evidence of progressive transformation of germinal centers & occasional mini clusters of epitheloid & giant cells without true granuloma formation or caseation necrosis. This is most consistent with: a. progressive transformation of germinal centers. b. Toxoplasmosis & other specific(none-Tb) infection. The skin lesion as seen by an expert dermatologist to be mostly as Tb of skin. What is your opinion about this case? Waiting your advice.