抗干扰素γ自身抗体综合征导致哥伦比亚分枝杆菌播散性感染一例

A case of Mycobacterium Columbia disseminated infection caused by anti-interferonγautoantibody syndrome

目的探讨抗干扰素(IFN)γ抗体综合征导致非结核分枝杆菌(哥伦比亚分枝杆菌)播散性感染的临床特点和治疗方法。方法1例66岁的老年女性因“反复发热伴淋巴结肿痛6个月”于2020年11月21日至深圳市第三人民医院住院治疗。分析该例IFN-γ抗体综合征导致的哥伦比亚分枝杆菌播散性感染者的临床诊疗经过,并行相关文献复习。结果该患者于外院行淋巴结活检组织、肺泡灌洗液宏基因组二代测序(mNGS)检测均提示哥伦比亚分枝杆菌感染。正电子发射计算机断层显像(PET-CT)示多处淋巴结肿大伴代谢升高,全身多处骨质破坏,右肺上叶前段病变伴高代谢。查体:全身皮疹,多处浅表淋巴结肿大,部分溃破伴少量脓液。入院查患者外周血:免疫球蛋白G定量、免疫球蛋白A定量、T淋巴细胞绝对计数、CD4^(+)T和CD8^(+)T细胞计数均正常。患者血液标本行IFN-γ抗体检测滴度为32700 ng/ml(正常值<5000 ng/ml),确诊为抗IFN-γ自身抗体免疫缺陷综合征导致的哥伦比亚分枝杆菌播散性感染。给予抗哥伦比亚分枝杆菌治疗,并给予丙种球蛋白和激素治疗,患者皮疹消退,破溃淋巴结愈合,肿大淋巴结明显缩小,病情好转,门诊继续给予抗非结核分枝杆菌治疗并随访。结论临床上对于非结核分枝杆菌播散性感染者,需要考虑到IFN-γ抗体综合征的可能,应行IFN-γ抗体检测,在针对病原体治疗的同时需进行免疫治疗。

Objective To investigate the clinical characteristics and treatment of a patient with nontuberculous mycobacterium(Mycobacterium Columbia)disseminated infection caused by anti-interferonγ(IFN-γ)autoantibody syndrome.Methods A 66-year-old woman was hospitalized on November 21st,2020 in Shenzhen Third People’s Hospital for“recurrent fever,with swollen and painful lymph nodes for 6 months”.The clinical course of this case with Mycobacterium Columbia disseminated infection caused by anti-IFN-γsyndrome was analyzed and relevant literatures were reviewed.Results Mycobacterium Columbia infection was identified both by metagenomic next-generation sequencing(mNGS)from lymph node tissue and alveolar lavage fluid of this patient performed in other hospital.Positron emission tomography computer tomography(PET-CT)showed multiple lymph node enlargement,multiple bone destruction throughout the body and consolidated right upper lobe of the lung with significant metabolic activity of this patient.Physical examination showed diffused skin rash and multiple superficial enlarged lymph nodes with ulcer and a few pus.Peripheral blood of this patient:quantification of immunoglobulin G and immunoglobulin A,absolute count of T-lymphocyte,count of CD4^(+)T cell and CD8^(+)T cell were all normal.The blood specimen was detected with IFN-γautoantibodies titer as 32700 ng/ml(normal value<5000 ng/ml),and the diagnosis of Mycobacterium Columbia disseminated infection caused by anti-IFN-γ,autoantibody immunodeficiency syndrome was confirmed.Anti-Mycobacterium Columbia treatment and gamma globulin and hormone therapy were carried out.The patient’s rash subsided,the ruptured lymph node healed,the enlarged lymph node reduced significantly,and the condition improved.Anti-nontuberculous mycobacterium treatment was continued during the outpatient treatment and follow-up.Conclusions Clinically,for disseminated nontuberculous mycobacterium-infected individuals,the possibility of anti-interferon antibody syndrome should be taken into account,and anti-IFN-γdetection should be performed to achieve the purpose of diagnosis,and immunotherapy should be performed besides treatment based on pathogen.