PULMONARY MANIFESTATIONS ACROSS SPECIFIC CATEGORIES OF PRIMARY IMMUNODEFICIENCIES

Mehmet Kılınç1 Kerim Yeşildağ2

1Batman Training and Research Hospital, Department of Immunology and Allergic Diseases, Batman, Türkiye
2Konya Necmettin Erbakan University, Faculty of Medicine, Department of Chest Diseases, Konya, Türkiye

Kılınç M, Yeşildağ K. Pulmonary Manifestations Across Specific Categories of Primary Immunodeficiencies. In: Arslan Ş editor. Pulmonary Pathologies and Management Strategies in Primary Immunodeficiencies. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.175-188.

ABSTRACT

Primary immunodeficiencies (PIDs) are a group of predominantly inherited disorders characterized by developmental, functional, or structural defects in one or more components of the immune system. More than 550 distinct PIDs have been identified, and the number continues to grow with the discovery of new genetic defects. The clinical manifestations vary depending on the type of immune defect, and the relationship between genotype and phenotype often exhibits considerable heterogeneity. Respiratory tract infections and their complications represent major causes of morbidity and mortality in patients with PID. While upper respiratory tract infections are common, lower respiratory tract complications-such as pneumonia, bronchiectasis, and interstitial lung diseases-tend to be more severe and are critical in determining disease prognosis. Respiratory involvement may result from both infectious and non-infectious causes. Therefore, early diagnosis and timely implementation of appropriate treatment strategies are essential to prevent or mitigate respiratory complications associated with PIDs.

Keywords: Primary immunodeficiencies; Pulmonary complications; Immune system dysfunction; Bronchiectasis; Interstitial lung disease

Referanslar

  1. Madkaikar M, Mishra A, Ghosh K. Diagnostic approach to primary immunodeficiency disorders. Indian Pediatrics. 2013;50(6):579-86. [Crossref]  [PubMed]
  2. Poli MC, Aksentijevich I, Bousfiha AA, Cunningham-Rundles C, Hambleton S, Klein C, et al. Human inborn errors of immunity: 2024 update on the classification from the International Union of Immunological Societies Expert Committee. Journal of Human Immunity. 2025;1(1):e20250003. [Crossref]
  3. Jesenak M, Banovcin P, Jesenakova B, Babusikova E. Pulmonary manifestations of primary immunodeficiency disorders in children. Frontiers in pediatrics. 2014;2:77. [Crossref]  [PubMed]  [PMC]
  4. Bierry G, Boileau J, Barnig C, Gasser B, Korganow AS, Buy X, et al. Thoracic manifestations of primary humoral immunodeficiency: a comprehensive review. Radiographics. 2009;29(7):1909-20. [Crossref]  [PubMed]
  5. Touw CM, Van De Ven AA, De Jong PA, Terheggen-Lagro S, Beek E, Sanders EA, et al. Detection of pulmonary complications in common variable immunodeficiency. Pediatric allergy and immunology. 2010;21(5):793-805. [Crossref]  [PubMed]
  6. O'Sullivan MD, Cant AJ. The 10 warning signs: a time for a change? Current opinion in allergy and clinical immunology. 2012;12(6):588-94. [Crossref]  [PubMed]
  7. Hampson F, Chandra A, Screaton N, Condliffe A, Kumararatne D, Exley A, et al. Respiratory disease in common variable immunodeficiency and other primary immunodeficiency disorders. Clinical radiology. 2012;67(6):587-95. [Crossref]  [PubMed]
  8. Jesenak M, Ciljakova M, Rennerova Z, Babusikova E, Banovcin P. Recurrent respiratory infections in children-definition, diagnostic approach, treatment and prevention. Bronchitis. IntechOpen; 2011. [Crossref]
  9. Notarangelo LD. Primary immunodeficiencies. Journal of Allergy and Clinical Immunology. 2010;125(2):S182-S94. [Crossref]  [PubMed]
  10. Agarwal S, Cunningham-Rundles C. Gastrointestinal manifestations and complications of primary immunodeficiency disorders. Immunology and allergy clinics of North America. 2019;39(1):81. [Crossref]  [PubMed]  [PMC]
  11. Winkelstein JA, Marino MC, Lederman HM, Jones SM, Sullivan K, Burks AW, et al. X-linked agammaglobulinemia: report on a United States registry of 201 patients. Medicine. 2006;85(4):193-202. [Crossref]  [PubMed]
  12. Tangye SG, Al-Herz W, Bousfiha A, Cunningham-Rundles C, Franco JL, Holland SM, et al. Human inborn errors of immunity: 2022 update on the classification from the international union of immunological societies expert committee. Journal of clinical immunology. 2022;42(7):1473-507. [Crossref]  [PubMed]  [PMC]
  13. Wood P, Stanworth S, Burton J, Jones A, Peckham D, Green T, et al. Recognition, clinical diagnosis and management of patients with primary antibody deficiencies: a systematic review. Clinical & Experimental Immunology. 2007;149(3):410-23. [Crossref]  [PubMed]  [PMC]
  14. Wahn V. When is susceptibility to infections abnormal? : Wiley Online Library; 2011:650-1. [Crossref]  [PubMed]
  15. Cunningham-Rundles C, Bodian C. Common variable immunodeficiency: clinical and immunological features of 248 patients. Clinical immunology. 1999;92(1):34-48. [Crossref]  [PubMed]
  16. Notarangelo LD, Plebani A, Mazzolari E, Soresina A, Bondioni MP. Genetic causes of bronchiectasis: primary immune deficiencies and the lung. Respiration. 2007;74(3):264-75. [Crossref]  [PubMed]
  17. Durandy A, Kracker S, Fischer A. Primary antibody deficiencies. Nature Reviews Immunology. 2013;13(7):519-33. [Crossref]  [PubMed]
  18. Quinti I, Soresina A, Spadaro G, Martino S, Donnanno S, Agostini C, et al. Long-term follow-up and outcome of a large cohort of patients with common variable immunodeficiency. Journal of clinical immunology. 2007;27:308-16. [Crossref]  [PubMed]
  19. Chapel H, Lucas M, Lee M, Bjorkander J, Webster D, Grimbacher B, et al. Common variable immunodeficiency disorders: division into distinct clinical phenotypes. Blood, The Journal of the American Society of Hematology. 2008;112(2):277-86. [Crossref]  [PubMed]
  20. Lucas M, Lee M, Lortan J, Lopez-Granados E, Misbah S, Chapel H. Infection outcomes in patients with common variable immunodeficiency disorders: relationship to immunoglobulin therapy over 22 years. Journal of Allergy and Clinical Immunology. 2010;125(6):1354-60. e4. [Crossref]  [PubMed]
  21. Park JH, Levinson AI. Granulomatous-lymphocytic interstitial lung disease (GLILD) in common variable immunodeficiency (CVID). Clinical immunology (Orlando, Fla). Feb 2010;134(2):97-103. [Crossref]  [PubMed]
  22. Conley ME, Dobbs AK, Farmer DM, Kilic S, Paris K, Grigoriadou S, et al. Primary B cell immunodeficiencies: comparisons and contrasts. Annual review of immunology. 2009;27:199-227. [Crossref]  [PubMed]
  23. Ochs HD, Smith CI. X-linked agammaglobulinemia. A clinical and molecular analysis. Medicine (Baltimore). Nov 1996;75(6):287-99. [Crossref]  [PubMed]
  24. Orange JS, Hossny EM, Weiler CR, Ballow M, Berger M, Bonilla FA, et al. Use of intravenous immunoglobulin in human disease: a review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology. The Journal of allergy and clinical immunology. Apr 2006;117(4 Suppl):S525-53. [Crossref]  [PubMed]
  25. Gathmann B, Mahlaoui N, Gérard L, Oksenhendler E, Warnatz K, Schulze I, et al. Clinical picture and treatment of 2212 patients with common variable immunodeficiency. The Journal of allergy and clinical immunology. Jul 2014;134(1):116-26. [Crossref]  [PubMed]
  26. Cunningham-Rundles C. Physiology of IgA and IgA deficiency. J Clin Immunol. Sep 2001;21(5):303-9. [Crossref]  [PubMed]
  27. Quinti I, Soresina A, Guerra A, Rondelli R, Spadaro G, Agostini C, et al. Effectiveness of immunoglobulin replacement therapy on clinical outcome in patients with primary antibody deficiencies: results from a multicenter prospective cohort study. J Clin Immunol. Jun 2011;31(3):315-22. [Crossref]  [PubMed]
  28. Cinicola BL, Pulvirenti F, Capponi M, Bonetti M, Brindisi G, Gori A, et al. Selective IgA deficiency and allergy: a fresh look to an old story. Medicina. 2022;58(1):129. [Crossref]  [PubMed]  [PMC]
  29. Buckley RH. Pulmonary complications of primary immunodeficiencies. Paediatric respiratory reviews. 2004;5:S225-S33. [Crossref]  [PubMed]
  30. Björkander J, Bake B, Oxelius V-A, Hanson LÅ. Impaired lung function in patients with IgA deficiency and low levels of IgG2 or IgG3. New England Journal of Medicine. 1985;313(12):720-4. [Crossref]  [PubMed]
  31. Ho H-e, Cunningham-Rundles C. Non-infectious complications of common variable immunodeficiency: updated clinical spectrum, sequelae, and insights to pathogenesis. Frontiers in immunology. 2020;11:149. [Crossref]  [PubMed]  [PMC]
  32. Bonilla FA, Khan DA, Ballas ZK, Chinen J, Frank MM, Hsu JT, et al. Practice parameter for the diagnosis and management of primary immunodeficiency. Journal of Al lergy and Clinical Immunology. 2015;136(5):1186-205. e78. [Crossref]  [PubMed]
  33. Schroeder HW, Jr., Cavacini L. Structure and function of immunoglobulins. The Journal of allergy and clinical immunology. Feb 2010;125(2 Suppl 2):S41-52. [Crossref]  [PubMed]  [PMC]
  34. Conley ME, Notarangelo LD, Etzioni A. Diagnostic criteria for primary immunodeficiencies. Representing PAGID (Pan-American Group for Immunodeficiency) and ESID (European Society for Immunodeficiencies). Clinical immunology (Orlando, Fla). Dec 1999;93(3):190-7. [Crossref]  [PubMed]
  35. Jeanes AC, Owens CM. Chest imaging in the immunocompromised child. Paediatr Respir Rev. Mar 2002;3(1):59-69. [Crossref]  [PubMed]
  36. Berrington JE, Flood TJ, Abinun M, Galloway A, Cant AJ. Unsuspected Pneumocystis carinii pneumonia at presentation of severe primary immunodeficiency. Archives of disease in childhood. Feb 2000;82(2):144-7. [Crossref]  [PubMed]  [PMC]
  37. Crooks BN, Taylor CE, Turner AJ, Osman HK, Abinun M, Flood TJ, et al. Respiratory viral infections in primary immune deficiencies: significance and relevance to clinical outcome in a single BMT unit. Bone marrow transplantation. Nov 2000;26(10):1097-102. [Crossref]  [PubMed]
  38. Almyroudis NG, Holland SM, Segal BH. Invasive aspergillosis in primary immunodeficiencies. Medical mycology. May 2005;43 Suppl 1:S247-59. [Crossref]  [PubMed]
  39. Sowerwine KJ, Holland SM, Freeman AF. Hyper-IgE syndrome update. Annals of the New York Academy of Sciences. Feb 2012;1250:25-32. [Crossref]  [PubMed]  [PMC]
  40. Freeman AF, Davis J, Anderson VL, Barson W, Darnell DN, Puck JM, et al. Pneumocystis jiroveci infection in patients with hyper-immunoglobulin E syndrome. Pediatrics. Oct 2006;118(4):e1271-5. [Crossref]  [PubMed]
  41. Gernez Y, Freeman AF, Holland SM, Garabedian E, Patel NC, Puck JM, et al. Autosomal Dominant Hyper-IgE Syndrome in the USIDNET Registry. The journal of allergy and clinical immunology In practice. May-Jun 2018;6(3):9961001. [Crossref]  [PubMed]  [PMC]
  42. Dosanjh A. Chronic pediatric pulmonary disease and primary humoral antibody based immune disease. Respiratory medicine. Apr 2011;105(4):511-4. [Crossref]  [PubMed]
  43. LAD LAD. Fagositer Hücre Yetmezlikleri. 2010.
  44. Paz HL, Little BJ, Ball Jr WC, Winkelstein JA. Primary pulmonary botryomycosis: a manifestation of chronic granulomatous disease. Chest. 1992;101(4):1160-2. [Crossref]  [PubMed]
  45. Jesenak M, Havlicekova Z, Banovcin P, Stasia M. Chronic granulomatous disease caused by a novel mutation in a 2-month-old boy with multifocal splenic abscesses. Journal of Investigational Allergology and Clinical Immunology. 2013;23(2):137-8.
  46. Dale DC, Cottle TE, Fier CJ, Bolyard AA, Bonilla MA, Boxer LA, et al. Severe chronic neutropenia: treatment and follow-up of patients in the Severe Chronic Neutropenia International Registry. American journal of hematology. 2003;72(2):82-93. [Crossref]  [PubMed]
  47. Copley S. Application of computed tomography in childhood respiratory infections. British medical bulletin. 2002;61(1):263-79. [Crossref]  [PubMed]
  48. Urschel S, Kayikci L, Wintergerst U, Notheis G, Jansson A, Belohradsky BH. Common variable immunodeficiency disorders in children: delayed diagnosis despite typical clinical presentation. The Journal of pediatrics. 2009;154(6):888-94. [Crossref]  [PubMed]
  49. Gharagozlou M, Ebrahimi F, Farhoudi A, Aghamohammadi A, Bemanian M-H, Chavoshzadeh Z, et al. Pulmonary complications in primary hypogammaglobulinemia: a survey by high resolution CT scan. Monaldi Archives for Chest Disease. 2006;65(2). [Crossref]  [PubMed]
  50. Tarzi MD, Grigoriadou S, Carr SB, Kuitert LM, Longhurst HJ. Clinical immunology review series: An approach to the management of pulmonary disease in primary antibody deficiency. Clinical and experimental immunology. Feb 2009;155(2):147-55. [Crossref]  [PubMed]  [PMC]
  51. Maglione PJ, Ko HM, Beasley MB, Strauchen JA, Cunningham-Rundles C. Tertiary lymphoid neogenesis is a component of pulmonary lymphoid hyperplasia in patients with common variable immunodeficiency. The Journal of allergy and clinical immunology. Feb 2014;133(2):535-42. [Crossref]  [PubMed]  [PMC]
  52. van de Ven AA, de Jong PA, Hoytema van Konijnenburg DP, Kessels OA, Boes M, Sanders EA, et al. Airway and interstitial lung disease are distinct entities in paediatric common variable immunodeficiency. Clinical and experimental immunology. Aug 2011;165(2):235-42. [Crossref]  [PubMed]  [PMC]
  53. Popa V, Colby TV, Reich SB. Pulmonary interstitial disease in Ig deficiency. Chest. Nov 2002;122(5):1594-603. [Crossref]  [PubMed]
  54. Bondioni MP, Soresina A, Lougaris V, Gatta D, Plebani A, Maroldi R. Common variable immunodeficiency: computed tomography evaluation of bronchopulmonary changes including nodular lesions in 40 patients. Correlation with clinical and immunological data. Journal of computer assisted tomography. May-Jun 2010;34(3):395-401. [Crossref]  [PubMed]
  55. Bates CA, Ellison MC, Lynch DA, Cool CD, Brown KK, Routes JM. Granulomatous-lymphocytic lung disease shortens survival in common variable immunodeficiency. The Journal of allergy and clinical immunology. Aug 2004;114(2):415-21. [Crossref]  [PubMed]
  56. Bondioni MP, Duse M, Plebani A, Soresina A, Notarangelo LD, Berlucchi M, et al. Pulmonary and sinusal changes in 45 patients with primary immunodeficiencies: computed tomography evaluation. Journal of computer assisted tomography. Jul-Aug 2007;31(4):620-8. [Crossref]  [PubMed]
  57. Cadranel J, Bouvry D, Wislez M. [Respiratory manifestations of common variable immunodeficiency in adults]. Revue des maladies respiratoires. Feb 2003;20(1 Pt 1):126-33.
  58. Torigian DA, LaRosa DF, Levinson AI, Litzky LA, Miller WT, Jr. Granulomatous-lymphocytic interstitial lung disease associated with common variable immunodeficiency: CT findings. Journal of thoracic imaging. Aug 2008;23(3):162-9. [Crossref]  [PubMed]
  59. Sacco O, Fregonese B, Picco P, Faraci M, Facchetti P, Pistoia V, et al. Common variable immunodeficiency presenting in a girl as lung infiltrates and mediastinal adenopathies leading to severe "superior vena caval" syndrome. The European respiratory journal. Sep 1996;9(9):1958-61. [Crossref]  [PubMed]
  60. Oztop I, Demirkan B, Tarhan O, Kayahan H, Yilmaz U, Kargi A, et al. The development of pulmonary adenocarcinoma in a patient with Job's syndrome, a rare immunodeficiency condition. Tumori. Jan-Feb 2004;90(1):132-5. [Crossref]  [PubMed]
  61. Agarwal S, Cunningham-Rundles C. Thymoma and immunodeficiency (Good syndrome): a report of 2 unusual cases and review of the literature. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. Feb 2007;98(2):185-90. [Crossref]  [PubMed]
  62. Cunningham-Rundles C, Lieberman P, Hellman G, Chaganti RS. Non-Hodgkin lymphoma in common variable immunodeficiency. Am J Hematol. Jun 1991;37(2):69-74. [Crossref]  [PubMed]
  63. Kajiwara S, Sakai S, Soeda H, Takahashi N, Okafuji T, Yoshimitsu K, et al. Multifocal nodular lymphoid hyperplasia of the lung. Journal of thoracic imaging. Aug 2005;20(3):239-41. [Crossref]  [PubMed]
  64. Rusconi F, Panisi C, Dellepiane RM, Cardinale F, Chini L, Martire B, et al. Pulmonary and sinus diseases in primary humoral immunodeficiencies with chronic productive cough. Archives of disease in childhood. Dec 2003;88(12):1101-5. [Crossref]  [PubMed]  [PMC]
  65. Modrzewska K, Wiatr E, Langfort R, Oniszh K, Roszkowski-Sliz K. [Common variable immunodeficiency in a patient with suspected sarcoidosis]. Pneumonologia i alergologia polska. 2009;77(1):91-6. [Crossref]
  66. Boĭkova NV. [Primary immunodeficiency state in a child with the pulmonary hypertension syndrome]. Arkhiv patologii. 1985;47(7):63-6.
  67. Trapnell BC, Carey BC, Uchida K, Suzuki T. Pulmonary alveolar proteinosis, a primary immunodeficiency of impaired GM-CSF stimulation of macrophages. Current opinion in immunology. Oct 2009;21(5):514-21. [Crossref]  [PubMed]  [PMC]
  68. Somech R, Somers GR, Chitayat D, Grunebaum E, Atkinson A, Kolomietz E, et al. Fatal lung fibrosis associated with immunodeficiency and gonadal dysgenesis in 46XX sisters--a new syndrome. American journal of medical genetics Part A. Jan 1 2008;146a(1):8-14. [Crossref]  [PubMed]