Otolaryngologic manifestations of immunodeficiency

A stepwise approach to the adult immunodeficiency evaluation for the rhinologist

PURPOSE OF REVIEW

Patients with an immunodeficiency may present to their Rhinologist with a history of recurrent, severe, and chronic infections. Therefore, it is essential for the Rhinologist to have a basic understanding of clinically relevant immune deficiencies.

RECENT FINDINGS

After describing different types of immunodeficiencies, their presentations, and management strategies, an evaluation algorithm is described.

SUMMARY

Through a collaborative approach, Rhinologists and Clinical Immunologists can provide comprehensive medical care to patients with immunodeficiencies.

Organ-based clues for diagnosis of inborn errors of immunity: A practical guide for clinicians

Inborn errors of immunity (IEI) comprise a group of about 490 genetic disorders that lead to aberrant functioning or the development of distinct immune system components. So far, a broad spectrum of IEI-related manifestations has been noted in the literature. Due to overlapping signs and symptoms of IEI, physicians face challenges in appropriately diagnosing and managing affected individuals. The last decade has witnesses improving in the molecular diagnosis of IEI patients. As a result, it can be the mainstay of diagnostic algorithms, prognosis, and possibly therapeutic interventions in patients with IEI. Furthermore, reviewing IEI clinical complications demonstrates that the manifestations and severity of the symptoms depend on the involved gene that causes the disease and its penetrance. Although several diagnostic criteria have been used for IEI, not every patient can be explored in the same way. As a result of the failure to consider IEI diagnosis and the variety of diagnostic capabilities and laboratory facilities in different regions, undiagnosed patients are increasing. On the other hand, early diagnosis is an almost essential element in improving the quality of life in IEI patients. Since there is no appropriate guideline for IEI diagnosis in different organs, focusing on the clues in the patient's chief complaint and physical exams can help physicians narrow their differential diagnosis. This article aims to provide a practical guide for IEI diagnosis based on the involved organ. We hope to assist clinicians in keeping IEI diagnosis in mind and minimizing possible related complications due to delayed diagnosis.

Multiple Simultaneous Complications of Acute Otitis Media in a Child Diagnosed with Chronic Granulomatous Disease: A Case Report

While the prevalence of acute otitis media complications in pediatric patients has decreased over the past 30 years because of effective antibiotic therapy, the incidence has begun to rise again recently, possibly because of increased antibiotic resistance. Patients who simultaneously manifest multiple complications may require a more thorough evaluation, including an immunologic work-up. The presented case should encourage physicians to investigate the possibility of an underlying immunodeficiency when treating patients with multiple simultaneous complications of acute otitis media.