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Salih H, Wai KCK, McKee J, Chopra C. Punctate inner choroidopathy in common variable immunodeficiency associated with a pathogenic variant in the tumour necrosis factor receptor superfamily 13b (TNFRSF13B) gene - Case report and review of the literature. Clin Immunol 2023; 255:109748. [PMID: 37652172 DOI: 10.1016/j.clim.2023.109748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/16/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Common variable immunodeficiency (CVID) has been recognised as the most common primary immunodeficiency in adulthood, and is characterised by increased susceptibility to infection, autoimmunity and increased risk of malignancies. Although ocular manifestations are not common in CVID, rare associated inflammatory eye conditions have been reported including submacular choroiditis. OBJECTIVE To report a case of punctate inner choroidopathy in a patient with common variable immunodeficiency. CASE PRESENTATION A 40-year-old lady with CVID and associated autoimmune thrombocytopenia, who was treated with immunoglobulin replacement and Eltrombopag, experienced gradually deteriorating right eye vision. Fundal examination and optical coherence tomography (OCT) revealed right multifocal retinal choroidal lesions consistent with a diagnosis of unilateral punctate inner choroidopathy (PIC) with secondary choroidal neovascularisation (CNV). Anti-VEGF injections led to stabilised fundal appearances. Genetic testing revealed a heterozygous sequence change c.260 T > Ap.(IIe87Asn), pathogenic variant in the Tumour Necrosis Factor Superfamily 13B (TNFRSF13B) gene, which is reported as being associated with ∼10% of CVID cases. CONCLUSION Autoimmunity may be the dominant clinical presenting feature of CVID. Punctuate inner choroidopathy is an idiopathic inflammatory chorioretinopathy, and to the best of our knowledge, has not been previously reported in CVID. A better understanding of the molecular bases of autoimmune diseases in CVID may provide novel therapeutic targets for autoimmune diseases in this patient population.
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Affiliation(s)
- Hiba Salih
- Clinical Immunology Registrar, Royal Infirmary of Edinburgh, Immunology, NHS Lothian, Edinburgh, UK.
| | - Kelvin Cheng Kah Wai
- Opthalmology Registrar, Princess Alexandra Eye Pavilion, Opthalmology, NHS Lothian, Edinburgh, UK
| | - Justin McKee
- Consultant Medical Opthalmologist, Princess Alexandra Eye Pavilion, Opthalmology, NHS Lothian, Edinburgh, UK
| | - Charu Chopra
- Clinical Immunology Registrar, Royal Infirmary of Edinburgh, Immunology, NHS Lothian, Edinburgh, UK; Consultant Clinical Immunology, Royal Infirmary of Edinburgh, Immunology, NHS Lothian, Edinburgh, UK
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Mohammadi F, Yadegar A, Mardani M, Ayati A, Abolhassani H, Rezaei N. Organ-based clues for diagnosis of inborn errors of immunity: A practical guide for clinicians. Immun Inflamm Dis 2023; 11:e833. [PMID: 37102642 PMCID: PMC10091206 DOI: 10.1002/iid3.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/24/2023] [Indexed: 04/28/2023] Open
Abstract
Inborn errors of immunity (IEI) comprise a group of about 490 genetic disorders that lead to aberrant functioning or the development of distinct immune system components. So far, a broad spectrum of IEI-related manifestations has been noted in the literature. Due to overlapping signs and symptoms of IEI, physicians face challenges in appropriately diagnosing and managing affected individuals. The last decade has witnesses improving in the molecular diagnosis of IEI patients. As a result, it can be the mainstay of diagnostic algorithms, prognosis, and possibly therapeutic interventions in patients with IEI. Furthermore, reviewing IEI clinical complications demonstrates that the manifestations and severity of the symptoms depend on the involved gene that causes the disease and its penetrance. Although several diagnostic criteria have been used for IEI, not every patient can be explored in the same way. As a result of the failure to consider IEI diagnosis and the variety of diagnostic capabilities and laboratory facilities in different regions, undiagnosed patients are increasing. On the other hand, early diagnosis is an almost essential element in improving the quality of life in IEI patients. Since there is no appropriate guideline for IEI diagnosis in different organs, focusing on the clues in the patient's chief complaint and physical exams can help physicians narrow their differential diagnosis. This article aims to provide a practical guide for IEI diagnosis based on the involved organ. We hope to assist clinicians in keeping IEI diagnosis in mind and minimizing possible related complications due to delayed diagnosis.
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Affiliation(s)
- Fatemeh Mohammadi
- School of MedicineTehran University of Medical SciencesTehranIran
- Universal Scientific Education and Research Network (USERN)Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA)TehranIran
| | - Amirhossein Yadegar
- School of MedicineTehran University of Medical SciencesTehranIran
- Universal Scientific Education and Research Network (USERN)Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA)TehranIran
| | - Mahta Mardani
- School of MedicineTehran University of Medical SciencesTehranIran
- Universal Scientific Education and Research Network (USERN)Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA)TehranIran
| | - Aryan Ayati
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart CenterTehran University of Medical ScienceTehranIran
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical CenterTehran University of Medical SciencesTehranIran
| | - Nima Rezaei
- Universal Scientific Education and Research Network (USERN)Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA)TehranIran
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical CenterTehran University of Medical SciencesTehranIran
- Primary Immunodeficiency Diseases Network (PIDNet)TehranIran
- Children's Medical CenterTehranIran
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Pham MN, Fuleihan RL, Sullivan KE, Cunningham-Rundles C. Ocular Manifestations in Primary Immunodeficiency Disorders: A Report From the United States Immunodeficiency Network (USIDNET) Registry. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1788-1796. [PMID: 35421605 DOI: 10.1016/j.jaip.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/10/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Few published studies address eye disease in primary immunodeficiency (PID) despite ocular infections and autoimmune disease being known manifestations of immunodeficient states. OBJECTIVE Data from the USIDNET Registry provide a resource to study ocular ailments in subjects with PID. METHODS Ocular manifestations and patient characteristics were determined using data from 4624 patients with PID enrolled in the US Immunodeficiency Network (USIDNET) Registry. RESULTS A total of 519 (11.2%) patients had recorded ocular diseases. Those with autoinflammatory disorders (n = 4 of 7 [57.1%]), intrinsic and innate immunity defects (n = 9 of 44 [20.5%]), and immune dysregulation (n = 27 of 142 [19.0%]) had the highest percentage of ocular diseases for the PID diagnosis category. Of the 67.6% with infections, 85.5% had conjunctivitis. Bacteria (56.2%) and viruses (27.4%) were the most common microorganisms reported, with Staphylococcus (31.7%), Haemophilus (26.8%), and Streptococcus (22.0%) being the most common bacteria isolated. Those with a history of eye infections had lower immunoglobulin levels, lower CD19 B-cell percentages, and a lower number of protective pneumococcal titers. In patients with noninfectious ocular complications, 30.8% had vision changes, with retina (n = 20 [8.0%]), cataract (n = 16 [6.4%]), and nerve diseases (n = 16 [6.4%]) also being common. Many patients with ocular disease had serious sequelae, with 12.7% undergoing eye surgery and 10.6% having a vision-based disability. CONCLUSIONS Vision loss and conjunctivitis were the most commonly reported ocular complications and pose large quality-of-life issues. Learning more about ocular disease in PID will increase awareness about the importance of addressing and evaluating for these ailments.
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Affiliation(s)
- Michele N Pham
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, Calif.
| | - Ramsay L Fuleihan
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Columbia University, New York, NY
| | - Kathleen E Sullivan
- Division of Allergy Immunology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa
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Retinal Occlusive Vasculitis in a Patient with Hyperimmunoglobulin E Syndrome. Case Rep Ophthalmol Med 2022; 2021:6317358. [PMID: 34976422 PMCID: PMC8718279 DOI: 10.1155/2021/6317358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022] Open
Abstract
Background Hyperimmunoglobulin E syndrome (HIES), or Job's syndrome, is a primary immunodeficiency disorder that is characterized by an elevated level of IgE with values reaching over 2000 IU (normal < 200 IU), eczema, and recurrent staphylococcus infection. Affected individuals are predisposed to infection, autoimmunity, and inflammation. Herein, we report a case of HIES with clinical findings of retinal occlusive vasculitis. Case Presentation. A 10-year-old boy with a known case of hyperimmunoglobulin E syndrome had exhibited loss of vision and bilateral dilated fixed pupil. Fundoscopic examination revealed peripheral retinal hemorrhaging, vascular sheathing around the retinal arteries and veins, and vascular occlusion in both eyes. A fluorescein angiography of the right eye showed hyper- and hypofluorescence in the macula and hypofluorescence in the periphery of the retina, peripheral arterial narrowing, and arterial occlusion. A fluorescein angiography of the left eye showed hyper- and hypofluorescence in the supranasal area of the optic disc. Macular optical coherence tomography of the right eye showed inner and outer retinal layer distortion. A genetic study was performed that confirmed mutations of the dedicator of cytokinesis 8 (DOCK 8). HSV polymerase chain reaction testing on aqueous humor and vitreous was negative, and finally, the patient was diagnosed with retinal occlusive vasculitis. Conclusion Occlusive retinal vasculitis should be considered as a differential diagnosis in patients with hyperimmunoglobulin E syndrome presenting with visual loss.
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Cunningham ET, Pichi F, Mahajan VB, Rosenbaum JT, Zierhut M. Genetics of Uveitis. Ocul Immunol Inflamm 2021; 29:215-218. [PMID: 33950774 DOI: 10.1080/09273948.2021.1910430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Emmett T Cunningham
- The Department of Ophthalmology, California Pacific Medical Center, San Francisco, California, USA.,The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA.,The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California, USA
| | - Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Vinit B Mahajan
- Omics Laboratory, Stanford University, Palo Alto, California, USA.,The Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - James T Rosenbaum
- The Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA.,The Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA.,Legacy Devers Eye Institute, Portland, Oregon, USA
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen, Tuebingen, Germany
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Nieves-Moreno M, Granados M, Noval S. Primary Immunodeficiency Diseases Presenting with Chalazia as the First Manifestation. Ocul Immunol Inflamm 2020; 29:257-259. [PMID: 32835554 DOI: 10.1080/09273948.2020.1794012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Purpose: Ocular manifestations in primary immunodeficiency diseases are rare, but they can be the initial manifestation. This can lead to the prompt diagnosis and treatment of the disease and achieve a reduction of severe systemic complications.Case Report: We present two cases where a recurrent giant chalazion was the symptom that led to the diagnosis and early treatment of a patient with X-linked chronic granulomatous disease (CGD), and a patient with hyperimmunoglobulin E syndrome.Conclusion: Even though chalazia are common and benign, children presenting with recurrent giant chalazia or torpid evolution after surgery should be investigated for immunodeficiencies to reduce the severe and potentially fatal complications of the disease.
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Affiliation(s)
- María Nieves-Moreno
- Department of Paediatric Ophthalmology, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - María Granados
- Department of Paediatric Ophthalmology, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - Susana Noval
- Department of Paediatric Ophthalmology, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
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Ngai JJ, Chong KL, Oli Mohamed S. Cytomegalovirus Retinitis in Primary Immune Deficiency Disease. Case Rep Ophthalmol Med 2018; 2018:8125806. [PMID: 30327738 PMCID: PMC6169215 DOI: 10.1155/2018/8125806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/03/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION To report an unusual case of CMV retinitis in Primary Immune Deficiency Disease (PIDD). CASE REPORT 13-year-old child with combined T and B cell deficiencies was diagnosed of bilateral zone 1 CMV retinitis. Intravitreal injections were unable to be given in a regular and timely manner under general anaesthesia due to her underlying systemic disease. The child was treated with intravenous ganciclovir for 8 weeks until eventual resolution of the retinitis. However, visual acuity deteriorated due to progressive optic nerve involvement. CONCLUSION Paediatric patients often do not notice subtle symptoms of CMV retinitis. Although ocular manifestations are uncommon in PIDD, recognition and high index of suspicion will allow for timely referral, diagnosis, and treatment to be instituted for better visual outcomes.
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Affiliation(s)
- Jia Jeane Ngai
- Department of Ophthalmology, Hospital Bintulu, Sarawak, Malaysia
| | - Ka Lung Chong
- Department of Ophthalmology, Hospital Bintulu, Sarawak, Malaysia
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A glance on recent progresses in diagnosis and treatment of primary immunodeficiencies/ Progrese recente în diagnosticul şi tratamentul imunodeficienţelor primare. REV ROMANA MED LAB 2014. [DOI: 10.2478/rrlm-2014-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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