Systemic tuberculosis with skin compromise in a pediatric patient with primary immunodeficiency

Authors

  • John A. Cabrera-Enriquez Carrera de Medicina Humana, Facultad de Ciencias de la Salud, Universidad San Ignacio de Loyola, Lima 15024 Perú; Servicio de Clínica Pediátrica. Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú https://orcid.org/0000-0002-0770-505X
  • L. Andrea Huanca-Carreño Carrera de Medicina Humana, Facultad de Ciencias de la Salud, Universidad San Ignacio de Loyola, Lima 15024 Perú; Clínica San Felipe. Lima, Perú
  • Luis Edgardo Gonzales-Huerta Carrera de Medicina Humana, Facultad de Ciencias de la Salud, Universidad San Ignacio de Loyola, Lima 15024 Perú

DOI:

https://doi.org/10.35434/rcmhnaaa.2023.164.2377

Keywords:

Primary Immunodeficiency Disorder, Extrapulmonary Tuberculosis, Cutaneous Ulcer, Tumor Necrosis Factor Receptors, Genetic Predisposition to Disease

Abstract

Background: Primary immunodeficiencies (PID) represent challenging pathologies in terms of diagnosis and treatment, with increased predisposition to recurrent respiratory and gastrointestinal infections.

Case report: A paediatric patient with pathologic variants of genes IFNGR1 and TNFRSF13B, presented an atypical manifestation of tuberculosis, characterized by cutaneous lesions and lack of respiratory symptoms. Patient was initially treated for an atypical mycobacterial infection with partial favourable response. Following microbiological confirmation of Mycobacterium tuberculosis, a proper antibiotic regimen was initiated, resulting in complete recovery.

Conclusion: PIDs increase the likelihood of atypical presentations of tuberculosis, complicating diagnosis and interfering with timely treatment. We report a case lacking the classic clinical criteria for immunodeficiency and with an atypical clinical presentation for M. tuberculosis infection, which led to a 2-month delay in the initiation of the most effective treatment.

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Author Biographies

John A. Cabrera-Enriquez , Carrera de Medicina Humana, Facultad de Ciencias de la Salud, Universidad San Ignacio de Loyola, Lima 15024 Perú; Servicio de Clínica Pediátrica. Hospital Nacional Guillermo Almenara Irigoyen. Lima, Perú

a. Médico Especialista en Enfermedades Infecciosas y Tropicales

L. Andrea Huanca-Carreño, Carrera de Medicina Humana, Facultad de Ciencias de la Salud, Universidad San Ignacio de Loyola, Lima 15024 Perú; Clínica San Felipe. Lima, Perú

a. Médica Especialista en Medicina de Emergencias y Desastres

Luis Edgardo Gonzales-Huerta, Carrera de Medicina Humana, Facultad de Ciencias de la Salud, Universidad San Ignacio de Loyola, Lima 15024 Perú

a. Doctor of Philosophy (PhD) in Clinical Medicine Research (Infectious Diseases)

References

Bagcchi S. WHO’s Global Tuberculosis Report 2022. The Lancet Microbe. 2023 Jan 1;4(1):e20. DOI: 10.1016/S2666-5247(22)00359-7

SM N, AJ B, S A, E W, B K. Paediatric Tuberculosis. Lancet Infect Dis. 2008 Aug;8(8):498–510. DOI: 10.1016/S1473-3099(08)70182-8

McCusker C, Upton J, Warrington R. Primary immunodeficiency. Allergy Asthma Clin Immunol. 2018 Sep 12;14(Suppl 2):61. DOI: 10.1186/s13223-018-0290-5

Cheng L, Zhang F, Wang Y, Chen J, Yuan X. Association between IFNGR1 gene polymorphisms and tuberculosis susceptibility: A meta-analysis. Front Public Health. 2022;10:976221. DOI: 10.3389/fpubh.2022.976221

Romberg N, Virdee M, Chamberlain N, Oe T, Schickel JN, Perkins T, et al. TNF receptor superfamily member 13b (TNFRSF13B) hemizygosity reveals transmembrane activator and CAML interactor haploinsufficiency at later stages of B-cell development. J Allergy Clin Immunol. 2015 Nov;136(5):1315–25. DOI: 10.1016/j.jaci.2015.05.012

Salzer U, Chapel HM, Webster ADB, Pan-Hammarström Q, Schmitt-Graeff A, Schlesier M, et al. Mutations in TNFRSF13B encoding TACI are associated with common variable immunodeficiency in humans. Nat Genet. 2005 Aug;37(8):820–8. DOI: 10.1038/ng1600

Liao M, Ye F, Zhang B, Huang L, Xiao Q, Qin M, et al. Genome-wide association study identifies common variants at TNFRSF13B associated with IgG level in a healthy Chinese male population. Genes Immun. 2012 Sep;13(6):509–13. DOI: 10.1038/gene.2012.26

Yarmohammadi H, Estrella L, Doucette J, Cunningham-Rundles C. Recognizing Primary Immune Deficiency in Clinical Practice. Clin Vaccine Immunol. 2006 Mar;13(3):329–32. DOI: 10.1128/CVI.13.3.329-332.2006

Kliegman R, Blum N, Shah S, St Geme J, Tasker R, Wilson K et al. Nelson. Tratado de pediatría. 21ª. Ed. Madrid: Elsevier; 2020.

Yi-Fan L, Peng-Wen N, Yao H, Ting X. Therapeutic strategies for chronic wound infection. Chin J Traumatol. 2022; 25(1):11-16. DOI: 10.1016/j.cjtee.2021.07.004

Frank C, Bayoumi I, Westendorp C. Approach to infected skin ulcers. Can Fam Physician. 2005; 51(10):1352-1359. PMID: 16250422; PMCID: PMC1479797.

Franco-Paredes C, Marcos LA, Henao-Martínez AF, Rodríguez-Morales AJ, Villamil-Gómez WE, Gotuzzo E et al. Cutaneous Mycobacterial Infections. Clin Microbiol Rev. 2019; 32(1). DOI: 10.1128/cmr.00069-18

Cooper AM, Dalton DK, Stewart TA, Griffin JP, Russell DG, Orme IM : Disseminated tuberculosis in interferon gamma gene-disrupted mice. J Exp Med 1993; 178: 2243–2247. DOI: 10.1084/jem.178.6.2243

Meyer, C., Intemann, C., Förster, B. et al. No significant impact of IFN-γ pathway gene variants on tuberculosis susceptibility in a West African population. Eur J Hum Genet 24, 748–755 (2016). DOI: 10.1038/ejhg.2015.172

Meyer CG, Thye T : Host genetic studies in adult pulmonary tuberculosis. Semin Immunol 2014; 26: 445–453. DOI: 10.1016/j.smim.2014.09.005

Published

2024-02-07

How to Cite

1.
Cabrera-Enriquez JA, Huanca-Carreño LA, Gonzales-Huerta LE. Systemic tuberculosis with skin compromise in a pediatric patient with primary immunodeficiency. Rev. Cuerpo Med. HNAAA [Internet]. 2024 Feb. 7 [cited 2024 May 18];16(4). Available from: https://cmhnaaa.org.pe/ojs/index.php/rcmhnaaa/article/view/2377