[Solved] A 25-year-old Male Immunodeficiency Case Study


Summary: Initial presentation A 25-year-old male with no previous medical history presents a 5-year history of recurrent sinus and chest infections. He has required 10 courses over the last year and usually needs a second course of antibiotics to clear them. He had 1 hospital admission for community-acquired pneumonia requiring IV antibiotics- A sputum culture […]

Q1. Explain why immunodeficiency was suspected from the initial presentation and describe the normal humoral response to extracellular encapsulated bacteria.

Immunodeficiency was suspected from the initial presentation because the patient reported an encounter with recurrent sinus and chest infections. Since the patient has been experiencing sinus infections and other respiratory infections, there is a chance that his body does not produce enough immunoglobulin G antibodies to facilitate immunity against the infections. The immunoglobulin G protects the body from diseases by binding many kinds of pathogens, such as viruses, bacteria, and fungi, and initiating the process through which such foreign materials are taken out of the body (1). It also paves the way for memory cells in the immune system to recognize familiar pathogens and initiate protective measures. As a result, inadequate production of the immunoglobulin G antibodies exposes individuals to frequent respiratory infections, sore throats, and pneumonia (2). Therefore, the patient may be said to have a defective humoral response or the cell-mediated response to respiratory infections.

Q 2. Justify what investigations you would request following his initial presentation.

Following the patient’s initial presentation, I would request the determination of his serum IgE levels, evaluation of functional antibody production and response after active immunization, and an assessment of the circulating T and B lymphocytes. Clinical assessments should focus on whether there is a sufficient concentration of serum IgE in the patient’s body. An IgE concentration of less than 2.5 IU/ml would indicate that the patient lacks the sufficient immune capacity to fight against respiratory infections (3). In that case, the patient may be diagnosed with diagnosed a common variable immunodeficiency, which relevant treatment strategies would follow. Conversely, high amounts of serum IgE would indicate that the patient’s immune system could overreact to an allergen, resulting in an allergic reaction (4). Similarly, the IgE concentration could be high if the body is fighting an infection from a parasite under varying immune system conditions. Such findings could, therefore, inform further therapeutic interventions.

It would also be important to assess the circulating T and B lymphocytes to establish any immunofluorescence staining of monoclonal antibodies. To maintain immunity, lymphocytes in the human circulating blood ought to predominantly comprise T cells with a low concentration of B cells (5 ). T-cells constitute the part of the immune system that focuses on identifying and responding to foreign particles that find their way into the body to cause illness. On the other hand, B cells are components of the adaptive immune system that mediate the production of antigen-specific immunoglobulin directed against invasive pathogens. Excessive amounts of B cells indicate irregularities in a person’s circulatory system that could limit the capacity of their immune system to fight infections (6). Similarly, T-cell deficiency results in the immunodeficiency of cell-mediated immunity. Assessing the concentration of B and T cells could illuminate further strategies to improve the patient’s body’s resilience to infections.

Q 3. Describe ongoing management options and considerations for follow-up.

Management options and considerations for follow-up include Ig replacement and the administration of antibiotics and immunosuppressants. Based on the current presentation by the patient, the condition is not curable and can only be treated symptomatically. It would, therefore, be important to conduct Ig replacement through regular administration of intravenous immune globulin to stimulate the patient’s immune response. Oral, inhaled, or intravenous administration of antibiotics could help alleviate respiratory infection symptoms and keep the patient safe from disease progression. Immunosuppressants could also be administered regularly to address irregularities in the immune system and ensure that antibodies do not mistakenly attack healthy cells and tissues in the patient’s body.

Works Cited

  1. Dekkers G, Rispens T, Vidarsson G. Novel concepts of altered immunoglobulin G galactosylation in autoimmune diseases. Frontiers in immunology. 2018 Mar 19;9:553. https://www.frontiersin.org/articles/10.3389/fimmu.2018.00553/full
  2. Mohammed SA, Seoud HA, Elhady M, Hassan AS. Estimating poliovirus immunoglobulin G antibodies in healthy, overweight, and obese children. The Scientific Journal of Al-Azhar Medical Faculty, Girls. 2021 Jul 1;5(3):555. https://www.sjamf.eg.net/article.asp?issn=1110-2381;year=2021;volume=5;issue=3;spage=555;epage=559;aulast=Mohammed
  3. Park M, Song Y, Kim KJ, Oh SJ, Ahn JK, Park H, Shin HB, Kwon SJ. Electrochemical Immunosensor for Human IgE Using Ferrocene Self-Assembled Monolayers Modified ITO Electrode. Biosensors. 2020 Apr;10(4):38. https://www.mdpi.com/690962
  4. Saeid AM, Naguib MS, Abdelmajid AF, Yousif YM. Assessment of Immunoglobulin E in Asthmatic Pediatric Patients. The Egyptian Journal of Hospital Medicine. 2021 Oct 1;85(1):3462-6. https://journals.ekb.eg/article_199602.html
  5. Kansal R, Richardson N, Neeli I, Khawaja S, Chamberlain D, Ghani M, Ghani QU, Balazs L, Baranova-Giorgianni S, Giorgianni F, Kochenderfer JN. Sustained B cell depletion by CD19-targeted CAR T cells is a highly effective treatment for murine lupus. Science translational medicine. 2019 Mar 6;11(482):eaav1648. https://www.frontiersin.org/articles/10.3389/fimmu.2020.00827/full?utm_source=fweb&utm_medium=nblog&utm_campaign=ba-sci-fimmu-covid-tcell-exhaustion
  6. Hofmann K, Clauder AK, Manz RA. Targeting B cells and plasma cells in autoimmune diseases. Frontiers in immunology. 2018 Apr 23;9:835. https://www.frontiersin.org/articles/10.3389/fimmu.2018.00835/full

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Published On: 01-01-1970

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