X-linked agammaglobulinemia with bronchiectasis and infection: a case report

  • LIN Jiayuan ,
  • CHENG Qijian ,
  • CHEN Ling
Expand
  • a. Department of Pharmacy; b. Department of Pulmonary & Critical Care Medicine, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China

Received date: 2025-01-04

  Online published: 2025-07-11

Abstract

X-linked agammaglobulinemia (XLA) is a rare disease characterized by severe hypogammaglobulinemia, antibody deficiency, and recurrent infections. This study reports a case of X-linked agammaglobulinemia combined with bronchiectasis and infection. The patient was a 45-year-old male with a disease course of more than 40 years, mainly presenting with recurrent infections such as pneumonia, sinusitis, and otitis media. After the patient was admitted due to bronchiectasis with infection this time, laboratory tests showed that the levels of IgM, IgA, and IgG were 0.24 g/L, 0.90 g/L, and 4.33 g/L, respectively, all significantly decreased, and the peripheral blood CD19+B lymphocyte count was 0.1%. Genetic testing results showed that the patient had a c.1095C>A (p.Asn365Lys) mutation in the Bruton's tyrosine kinase (Btk) gene. This case suggests that male patients with a history of recurrent infections and imaging evidence of bronchiectasis should further understand their family history, improve humoral and cellular immune testing, and perform genetic testing in a timely manner, which is beneficial for the early diagnosis and treatment of XLA.

Cite this article

LIN Jiayuan , CHENG Qijian , CHEN Ling . X-linked agammaglobulinemia with bronchiectasis and infection: a case report[J]. Journal of Diagnostics Concepts & Practice, 2025 , 24(02) : 233 -237 . DOI: 10.16150/j.1671-2870.2025.02.016

References

[1] DO?RUEL D, SERBES M, A? ?A?IHüSEYINO?LU, et al. Clinical and genetic profiles of patients with X-linked agammaglobulinemia from southeast Turkey: Novel mutations in BTK gene[J]. Allergol Immunopathol (Madr),2019,47(1):24-31.
[2] VU Q V, WADA T, LE H T, LE H T, et al. Clinical and mutational features of Vietnamese children with X-linked agammaglobulinemia[J]. BMC Pediatr, 2014,14:129.
[3] ALMONTASHERI A, AL-HUSAYNI F, ALSURAIHI A K, et al. The clinical course of COVID-19 pneumonia in a 19-year-old man on intravenous immunoglobulin replacement therapy for X-linked agammaglobulinemia[J]. Am J Case Rep, 2021, 22:e929447.
[4] YEH Y H, HSIEH M Y, LEE W I, et al. Distinct clinical features and novel mutations in taiwanese patients with X-linked agammaglobulinemia[J]. Front Immunol. 2020,11:2001.
[5] 张抒扬. 罕见病诊疗指南2019年版[M].北京:人民卫生出版社,2019:768.
  ZHANG S Y. Rare disease diagnosis and treatment guidelines 2019 Edition[M]. Beijing:People’s Medical Publishing House,2019:768.
[6] HERNANDEZ-TRUJILLO V, ZHOU C, SCALCHUNES C, et al. A registry study of 240 patients with X-linked agammaglobulinemia living in the USA[J]. J Clin Immunol,2023,43(6):1468-1477.
[7] BUCKLEY R H. Pulmonary complications of primary immunodeficiencies[J]. Paediatr Respir Rev,2004,5 ():S225-S233.
[8] SHILLITOE B, DUQUE J S R, Lai S H Y, et al. Outcomes of X-linked agammaglobulinaemia patients[J]. J Clin Immunol,2024,45(1):40.
[9] O'TOOLE D, GROTH D, WRIGHT H, et al. X-Linked agammaglobulinemia:infection frequency and infection-related mortality in the USIDNET registry[J]. J Clin Immunol,2022,42(4):827-836.
[10] WEINBERGER T, FULEIHAN R, CUNNINGHAM-RUNDLES C, et al. Factors beyond lack of antibody govern pulmonary complications in primary antibody deficiency[J]. J Clin Immunol,2019,39(4):440-447.
[11] CONLEY M E, NOTARANGELO L D, ETZIONI A. Diagnostic criteria for primary immunodeficiencies.Represen-ting PAGID(Pan-American Group for Immunodeficiency)and ESID(European Society for Immunodeficiencies)[J]. Clin Immunol,1999,93(3):190-197.
[12] RICHARDS S, AZIZ N, BALE S, et al. ACMG Laboratory Quality Assurance Committee. Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology[J]. Genet Med,2015,17(5):405-424.
[13] SHILLITOE B M J, GENNERY A R. An update on X-linked agammaglobulinaemia: clinical manifestations and management[J]. Curr Opin Allergy Clin Immunol,2019,19(6):571-577.
[14] 中华医学会儿科学分会免疫学组,中华儿科杂志编辑委员会. 原发性免疫缺陷病免疫球蛋白G替代治疗专家共识[J]. 中华儿科杂志,2019,57(12):909-912.
  The Subspecialty Group of Immunology, the Society of Pediatrics, Chinese Medical Association; the Editorial Board, Chinese Journal of Pediatrics. Expert consensus on immunoglobulin G replacement therapy in primary immunodeficiency disease[J]. Chin J Pediatr,2019,57(12):909-912.
[15] GRIGORIADOU S, CLUBBE R, GARCEZ T, et al. British Society for Immunology and United Kingdom Primary Immunodeficiency Network (UKPIN) consensus guideline for the management of immunoglobulin replacement therapy[J]. Clin Exp Immunol, 2022,210(1):1-13.
[16] MILITO C, PULVIRENTI F, CINETTO F, et al. Double-blind, placebo-controlled, randomized trial on low-dose azithromycin prophylaxis in patients with primary antibody deficiencies[J]. J Allergy Clin Immunol,2019,144(2):584-593.
[17] JUN L Z, GEN W, MIN X. Clinical efficacy and safety of allogeneic hematopoietic stem cell transplantation in treating X-linked agammaglobulinemia[C]. EBMT 51st Annual Meeting, 2025.
Outlines

/