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

Medicine (Baltimore). 2020 Sep 4;99(36):e21738. doi: 10.1097/MD.0000000000021738.

Abstract

Introduction: Anti-interferon-gamma (anti-IFN-γ) autoantibody increases susceptibility to lower-virulence pathogens and causes immunodeficiency syndrome in HIV-negative patients.

Patient concerns: 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.

Diagnosis: 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.

Interventions: The patient underwent long-term anti-NTM and corticosteroid maintenance treatment.

Outcomes: 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.

Conclusion: 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.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Autoantibodies / immunology*
  • 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

Substances

  • Autoantibodies
  • Interferon-gamma