Secondary Immunodeficiencies a monocentric experience.

Secondary immunodeficiencies (SID) are acquired declines of immune cell counts and or/ function. The distinction between Inborn errors of immunity(IEIs) and SID sometimes is a challenge for the immunologist, the latter being more frequently diagnosed than IEIs and can occur as a consequence of malnutrition, metabolic disorders, use of immunosuppressive medications, chronic infections, malignancies and severe trauma among others.
We describe pediatric and adult patients with secondary immunodeficiencies in a single center of Argentina. METHOD: 33 patients (pts) with SID were included in a retrospective analysis of clinical records from our outpatient clinic from 01.2008 until 01.2023. 2pts in the follow up were recategorized with Common variable immunodeficiency and excluded. RESULTS: 21 females and 10 males. The median age was 39yo (range 4-87 yo). The causes of SID were: 11/31pts (35.48%) oncohematological diseases (CLL, Hodgkin’s disease, non-Hodgkin lymphoma), 4/31pts (12.90%) antiepileptic treatment (valproate, lamotrigine and clobazam), 4/31pts (12.90%) protein loss, 2/31pts (6.45% ) rheumatological diseases, 2/31pts (6.45%) immune system immaturity, 1/31pt (3.22%) pos-rituximab,1/31pt (3.22%) with hystiocitosis, and 7/31pts (22.58 %) no cause were identified and IEI was rule out. Diagnosed was based on: hypogammaglobulinemia 24/31pts (77.41%). IgG mean serum level: 510 mg/dl (range 108 mg/dl-1305 mg/dl). Poor Response to vaccines 7/31pts(22,58%), Lymphocytes subsets with B-cell lymphopenia 10/31pts(32.25%). Treatment: 9/31pts (29.03%) were under Immunoglobulin replacement therapy due to severe infections. 8/31pts(25,80%) had prophylactic antibiotics due to mild infections.
Is known that patients with IEIs have an increase of malignancies and autoimmune disorders, highly variable presentation mean that antibody deficiencies initially attributed to SID due to underlying disease and/or therapeutic agents used to treat hematological malignancies and autoimmune disorders, may actually be due to an underlying IEI.
Key words: secondary immunodeficiencies, inborn error of immunity, b cells, Immunoglobulin replacement therapy.

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