In case of recurrent wheezing and bronchiolitis: Think again, it may be a primary immunodeficiency

Begum Ozbek, Deniz Cagdas Ayvaz, Saliha Esenboga, Sevil Oskay Halacli, Elif Soyak Aytekin, Ismail Yaz, Cagman Tan, Ilhan Tezcan

Division of Pediatric Immunology, Hacettepe University, Ihsan Dogramaci Children’s Hospital, Ankara, Turkey

Abstract

Background: Wheezing, starting early in life, is a heterogeneous medical condition caused by airway obstruction due to different underlying mechanisms. Primary immunodeficiencies are also among the risk factors that cause wheezing and recurrent bronchiolitis. ADA deficiency is a primary immunodeficiency, also a rare metabolic disease associated with multisystemic clinical findings.
Objective: This report will be helpful for adressing the importance of thinking primary immunodeficiency in case of wheezing and recurret bronchiolitis.
Methods: The patient was diagnosed by using a targeted next generation sequencing PID panel. Lymphocyte subsets were measured by flow-cytometry.
Results: Here we present an infant with ADA deficiency who admitted with wheezing and recurrent bronchiolitis as the first presentation. He was found to have wheezing, relative CD4+ T cell deficiency, and prolonged neutropenia.
Conclusion: Primary immunodeficiencies including ADA deficiency should be considered in infants with wheezing, recurrent bronchiolitis, lymphopenia and neutropenia.
Key words: Wheezy infant, Lymphopenia, relative CD4 deficiency, Primary Immunodeficiency, ADA deficiency,