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Allergologia et Immunopathologia
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Original Article
DOI: 10.1016/j.aller.2020.02.009
Available online 21 May 2020
Autoimmune and inflammatory manifestations in pediatric patients with primary immunodeficiencies and their importance as a warning sign
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M. Yildirim Kaplan, S. Ozen
Corresponding author
yarenseli85@hotmail.com

Corresponding author.
, O. Akcal, N. Gulez, F. Genel
University of Health Sciences Izmir Dr. Behcet Uz Children's Education and Research Hospital, Division of Pediatric Allergy and Immunology, Izmir, Turkey
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Abstract
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Tables (4)
Table 1. Distribution of determined mutations of PID patients with autoimmune/inflammatory manifestations.
Table 2. The prevalence of autoimmune and inflammatory findings in PID diagnostic groups.
Table 3. Demographic, clinical features and the frequency of most common autoimmune/inflammatory manifestations by PID type.
Table 4. Demographic and clinical features according to the number of autoimmune/inflammatory manifestations and outcomes.
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Abstract
Introduction and objectives

As well as increased susceptibility to infections, autoimmune and inflammatory manifestations also eventuate due to dysregulation of immune system in a substantial proportion of patients with primary immunodeficiency (PID). Autoimmune and inflammatory manifestations can occur prior or after diagnosis of PID. This study aimed to evaluate autoimmune and inflammatory complications among all types of PID patients in childhood and to emphasize the importance of these findings as a warning sign to diagnose PIDs.

Methods

Medical records of 1036 patients with PID, followed up between 2003 and 2019, were retrospectively screened for occurrence of autoimmunity and inflammation. During this time, demographic features, autoimmune/inflammatory findings and initial time, genetic mutations, laboratory and clinical follow up findings, treatment regimens and outcomes were recorded.

Results

Autoimmune and inflammatory manifestations were observed in 83 patients (10.1%). The median age of autoimmunity initial time was 61.3±53 months. Sixty-seven (80.7%) patients presented with autoimmune and inflammatory manifestations, and these findings had occurred during 16 patients’ (19.3%) follow-up. The most common autoimmune manifestations were autoimmune hematologic (51.8%) and endocrine diseases (26.5%). Fifty patients (60.2%) had a single autoimmune/inflammatory manifestation, however 23 patients (27.7%) had two, eight patients (9.6%) had three and two patients (2.4%) had four different types of autoimmune/inflammatory manifestations. The frequency of autoimmune and inflammatory manifestations in phagocyte defects (56%), combined immune deficiencies (53%) and immune dysregulation diseases (52%) were observed higher than other forms of PIDs. During follow-up 13 (15.7%) patients died.

Conclusion

Autoimmune/inflammatory manifestations are associated with high morbidity in patients with PIDs and may precede the diagnosis of PID in childhood. Therefore, physicians must be aware of underlying possible immune deficiency and patients with known PIDs should be evaluated for autoimmune and inflammatory complications.

Keywords:
Primary immunodeficiency
Autoimmunity
Inflammation
Abbreviations:
ADA
AHA
ANA
APECED
CVID
DM
HLH
HSCT
IPEX
ITP
PID
PUVA
SPSS
WAS

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