Non-tuberculous mycobacterial infection and reactive dermatosis associated with adult-onset immunodeficiency due to anti–interferon-gamma autoantibodies A case report

• Published in: Medicine (Baltimore) Vol. 99; no. 36; p. e21738
• Main Authors: Liang, Xiao-Na, Bin, Yan-Fei, Lai, Guan-Ting, Li, Ying-Hua, Zhang, Jian-Quan, Zhong, Xiao-Ning, Bai, Jing, Li, Mei-Hua, Deng, Jing-Min, He, Zhi-Yi
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 04.09.2020
• Subjects: Aged; Autoantibodies - immunology; Clinical Case Report; Humans; Immunologic Deficiency Syndromes - complications; Immunologic Deficiency Syndromes - diagnosis; Immunologic Deficiency Syndromes - immunology; Interferon-gamma - immunology; Male; Mycobacterium Infections, Nontuberculous - complications; Mycobacterium Infections, Nontuberculous - diagnosis; Mycobacterium Infections, Nontuberculous - immunology; Opportunistic Infections - complications; Skin Diseases - complications; Skin Diseases - immunology
• ISSN: 0025-7974; 1536-5964; 1536-5964
• DOI: 10.1097/MD.0000000000021738

Anti-interferon-gamma (anti-IFN-γ) autoantibody increases susceptibility to lower-virulence pathogens and causes immunodeficiency syndrome in HIV-negative patients. A 69-year-old Chinese man presented with a 2-month history of pruritic skin lesions on his forearms, trunk, and legs. He was diagnosed with 5 opportunistic infections without conventional immunosuppression-associated factors in past. The most conspicuous characteristics were recurrent pulmonary infection, persistent immunoglobulin E elevation and eosinophilia during the whole disease course. Enzyme-linked immunosorbent assay showed anti-IFN-γ autoantibody positive. The final diagnosis for the patient was adult-onset immunodeficiency due to anti-IFN-γ autoantibody, non-tuberculous mycobacterial (NTM) infection and reactive dermatosis. The patient underwent long-term anti-NTM and corticosteroid maintenance treatment. The patient was followed for 2 years during which opportunistic infection no longer happened, the immunoglobulin E level and eosinophil count reduced, the autoantibody levels remained largely steady and lung lesions absorbed. Clinicians should be vigilant for NTM infection in patients with anti-IFN-γ autoantibodies, even when culture results are negative. Long-term anti-non-tuberculous mycobacteria and glucocorticoid regimens were effective.