Severe atopic dermatitis and transient hypogammaglobulinemia in children

Atopic dermatitis leading to failure to thrive: A case report

We present an infant with severe atopic dermatitis, protein loss, and subsequent failure to thrive. With proper management, the patient's laboratory findings normalized, and he gained weight appropriately. In this report, we highlight the impact that severe atopic dermatitis may have growth and development and review the genetic conditions that can result in a similar clinical presentation.

Common features of atopic dermatitis with hypoproteinemia

Purpose

The purpose of this study was to identify the causes, symptoms, and complications of hypoproteinemia to prevent hypoproteinemia and provide appropriate treatment to children with atopic dermatitis.

Methods

Children diagnosed with atopic dermatitis with hypoproteinemia and/or hypoalbuminemia were retrospectively reviewed. The patients’ medical records, including family history, weight, symptoms, treatment, complications, and laboratory test results for allergies and skin cultures, were examined.

Results

Twenty-six patients (24 boys) were enrolled. Seven cases had growth retardation; 7, keratoconjunctivitis; 6, aural discharges; 5, eczema herpeticum; 4, gastrointestinal tract symptoms; and 2, developmental delays. In 21 cases, topical steroids were not used. According to the blood test results, the median values of each parameter were elevated: total IgE, 1,864 U/mL; egg white-specific IgE, 76.5 kU_A/L; milk IgE, 20.5 kU_A/L; peanut IgE, 30 kU_A/L; eosinophil count, 5,810/μL; eosinophil cationic protein, 93.45 μg/L; and platelet count, 666.5×10³/μL. Serum albumin and total protein levels decreased to 2.7 g/dL and 4.25 g/dL, respectively. Regarding electrolyte abnormality, 10 patients had hyponatremia, and 12, hyperkalemia. Systemic antibiotics were used to treat all cases, and an antiviral agent was used in 12 patients. Electrolyte correction was performed in 8 patients.

Conclusion

Hypoproteinemia accompanying atopic dermatitis is common in infants younger than 1 year and may occur because of topical steroid treatment continuously being declined or because of eczema herpeticum. It may be accompanied by growth retardation, keratoconjunctivitis, aural discharge, and eczema herpeticum and can be managed through skin care and topical steroid application without intravenous albumin infusion.

Agammaglobulinemia and lack of immunization protection in exudative atopic dermatitis

Atopic dermatitis is very frequent in the first 6 months of life, and the severe exudative form of this skin disorder is by no means rare. Failure to achieve immunization protection is a potentially life-threatening complication of exudative atopic dermatitis that may go unrecognized. We report the case of a 6-month-old infant with severe exudative atopic dermatitis in whom hypoproteinemia and agammaglobulinemia were attributed to the massive exudation after exclusion of other possible causes. The patient failed to respond to standard immunization, and adequate protection with a good antibody response could be achieved only after exudation from the skin lesions had been treated by intensive topical skin therapy and multiple intravenous immunoglobulin substitution. Two otherwise similar earlier case reports did not investigate the immune status. Therefore, to the best of our knowledge, this is the first report to draw attention to absence of immunization protection in exudative atopic dermatitis.

CONCLUSION

We hope that our case report will motivate pediatricians to check the immunization status of patients with exudative atopic dermatitis and take the necessary steps to improve their care.