반복되는 쌕쌕거림이 있는 소아에서 IgG 아형 결핍의 진단과 치료 1예
Diagnosis and treatment of immunoglobulin G subclass deficiency in a school-age child with recurrent wheezing
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초록
Differential diagnosis of recurrent wheezing in school-age children includes not only asthma but also immunodeficiency. Immunoglobulin G (IgG) subclass deficiency is deficiency of 1 or more IgG subclasses (<2 standard deviations below the mean for age). IgG subclass deficiency in children may be associated with frequent respiratory tract infection and wheezing. An 8-year-old female patient had recurrent respiratory tract infection and wheezing despite the use of inhaled corticosteroids after the first wheezing around 100 days of age. The results of chest radiography, high resolution computed tomography of the chest, and spirometry were normal. In methacholine challenge test, provocation concentration causing a 20% fall in forced expiratory volume in 1 second was 18.29 mg/mL. Her total IgG was within the normal limit on the immunologic evaluation, but the IgG3 and IgG4 levels were decreased. She was diagnosed with IgG3 and IgG4 subclass deficiency. After intravenous immunoglobulin G (IVIG) infusion every 4–6 weeks, the number of respiratory tract infection and wheezing, the doses of systemic corticosteroids, and duration of antibiotic therapy were reduced. This case suggests that even in pediatric patients, if there are frequent respiratory tract infection and poorly controlled asthma, IgG subclass deficiency is suspected and clinical symptoms can be alleviated through IVIG treatment.
Abstract
Differential diagnosis of recurrent wheezing in school-age children includes not only asthma but also immunodeficiency. Immunoglobulin G (IgG) subclass deficiency is deficiency of 1 or more IgG subclasses (<2 standard deviations below the mean for age). IgG subclass deficiency in children may be associated with frequent respiratory tract infection and wheezing. An 8-year-old female patient had recurrent respiratory tract infection and wheezing despite the use of inhaled corticosteroids after the first wheezing around 100 days of age. The results of chest radiography, high resolution computed tomography of the chest, and spirometry were normal. In methacholine challenge test, provocation concentration causing a 20% fall in forced expiratory volume in 1 second was 18.29 mg/mL. Her total IgG was within the normal limit on the immunologic evaluation, but the IgG3 and IgG4 levels were decreased. She was diagnosed with IgG3 and IgG4 subclass deficiency. After intravenous immunoglobulin G (IVIG) infusion every 4–6 weeks, the number of respiratory tract infection and wheezing, the doses of systemic corticosteroids, and duration of antibiotic therapy were reduced. This case suggests that even in pediatric patients, if there are frequent respiratory tract infection and poorly controlled asthma, IgG subclass deficiency is suspected and clinical symptoms can be alleviated through IVIG treatment.
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