Disseminated drug-resistant tuberculosis and multiple autoimmune syndrome in a child with selective IgA deficiency-An uncustomary combination.

Publisher: Wiley on behalf of the Asia Pacific League of Associations for Rheumatology Country of Publication: England NLM ID: 101474930 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1756-185X (Electronic) Linking ISSN: 17561841 NLM ISO Abbreviation: Int J Rheum Dis Subsets: MEDLINE

Original Publication: [Oxford, UK] : Wiley on behalf of the Asia Pacific League of Associations for Rheumatology

Autoimmunity*; Autoimmune Diseases/*complications ; IgA Deficiency/*complications ; Tuberculosis, Multidrug-Resistant/*complications; Autoimmune Diseases/immunology ; Child ; Female ; Humans ; IgA Deficiency/immunology ; Syndrome ; Tuberculosis, Multidrug-Resistant/immunology

Polyautoimmunity or multiple autoimmune syndrome (MAIS) is increasingly being recognized in pediatric clinical practice, often in conjunction with systemic lupus erythematosus (SLE). Besides multi-organ autoimmunity, children with SLE are often at a higher risk of developing infections including tuberculosis. The tendency to develop infections and multiple autoimmune diseases in childhood SLE often occurs in the absence of monogenic primary immunodeficiency disease. Conversely, children with inborn errors of immunity, of which selective IgA deficiency (sIgAD) is the most common, may develop recurrent infections and autoimmune disorders including SLE. Herein, we report a child with MAIS (including SLE) and sIgAD who developed drug-resistant tuberculosis, which was managed successfully with second-line anti-tubercular drug therapy. To the best of our knowledge, this combination of rare findings has not been reported previously in the pediatric literature. Although a majority of patients with sIgAD are either asymptomatic or have mild infections/autoimmunity, the index child had a myriad of infectious illnesses and multi-organ autoimmunity. Our case highlights the prudence of thoroughly evaluating children with SLE for other autoimmune diseases and vice versa. Given the higher probability of inherited disorders, including early complement deficiencies and monogenic interferonopathies, in childhood SLE compared with adult SLE, it may be prudent to perform a basic immunological workup (for example, immunoglobulin levels, 50% hemolytic complement) in such patients. A more extensive immunological and genetic evaluation (including next-generation sequencing) may also be required in the presence of unusual clinical or laboratory features, a positive family history, or a complicated clinical course.
(© 2022 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

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Keywords: antiphospholipid syndrome; autoimmune thyroiditis; primary immunodeficiency diseases; systemic lupus erythematosus; tuberculosis

Date Created: 20220120 Date Completed: 20220318 Latest Revision: 20220318

20231215

10.1111/1756-185X.14289

35048520