Atypical X-linked agammaglobulinaemia caused by a novel BTK mutation in a selective immunoglobulin M deficiency patient

Lee Moay Lim, Jer Ming Chang, I. Fang Wang, Wei Chiao Chang, Daw Yang Hwang, Hung Chun Chen

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: X-linked agammaglobulinaemia (XLA) is the most common inherited humoural immunodeficiency disorder. Mutations in the gene coding for Bruton's tyrosine kinase (BTK) have been identified as the cause of XLA. Most affected patients exhibit a marked reduction of serum immunoglobulins, mature B cells, and an increased susceptibility to recurrent bacterial infections. However, the diagnosis of XLA can be a challenge in certain patients who have near-normal levels of serum immunoglobulin. Furthermore, reports on XLA with renal involvement are scant.Case presentation: We report an atypical XLA patient who presented with selective immunoglobulin M (IgM) immunodeficiency and nephropathy. He was diagnosed with selective IgM immunodeficiency, based on his normal serum immunoglobulin G (IgG) and immunoglobulin A (IgA) levels but undetectable serum IgM level. Intravenous immunoglobulin was initiated due to increased infections and persistent proteinuria but no improvement in proteinuria was found. A lupus-like nephritis was detected in his kidney biopsy and the proteinuria subsided after receiving a mycophenolate mofetil regimen. Although he had a history of recurrent bacterial infections since childhood, XLA was not diagnosed until B-lymphocyte surface antigen studies and a genetic analysis were conducted.Conclusions: We suggest that B-lymphocyte surface antigen studies and a BTK mutation analysis should be performed in familial patients with selective IgM deficiency to rule out atypical XLA.

Original languageEnglish
Article number150
JournalBMC Pediatrics
Volume13
Issue number1
DOIs
Publication statusPublished - Sep 27 2013

Keywords

  • Bruton's tyrosine kinase
  • Haematuria
  • Immunoglobulin
  • Proteinuria
  • X-linked agammaglobulinaemia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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