Division of Pediatric Metabolism and Nutrition, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
J Pediatr Endocrinol Metab. 2020 Dec 16;34(3):277-294. doi: 10.1515/jpem-2020-0277. Print 2021 Mar 26.
Inborn errors of metabolism consist of a heterogeneous group of disorders with various organ systems manifestations, and some metabolic diseases also cause immunological disorders or dysregulation. In this review, metabolic diseases that affect the immunological system and particularly lead to primary immune deficiency will be reviewed. In a patient with frequent infections and immunodeficiency, the presence of symptoms such as growth retardation, abnormal facial appearance, heart, skeletal, lung deformities, skin findings, arthritis, motor developmental retardation, seizure, deafness, hepatomegaly, splenomegaly, impairment of liver function tests, the presence of anemia, thrombocytopenia and eosinophilia in hematological examinations should suggest metabolic diseases for the underlying cause. In some patients, these phenotypic findings may appear before the immunodeficiency picture. Metabolic diseases leading to immunological disorders are likely to be rare but probably underdiagnosed. Therefore, the presence of recurrent infections or autoimmune findings in a patient with a suspected metabolic disease should suggest that immune deficiency may also accompany the picture, and diagnostic examinations in this regard should be deepened.
先天性代谢缺陷病是一组异质性疾病,可累及多个器官系统,某些代谢性疾病也可引起免疫紊乱或失调。本篇综述将对影响免疫系统并可导致原发性免疫缺陷的代谢性疾病进行讨论。在频繁发生感染和免疫缺陷的患者中,如果出现生长迟缓、面容异常、心脏、骨骼、肺部畸形、皮肤表现、关节炎、运动发育迟缓、癫痫、耳聋、肝肿大、脾肿大、肝功能检查异常、贫血、血小板减少和血液检查中嗜酸性粒细胞增多等症状,应考虑代谢性疾病为潜在病因。在一些患者中,这些表型表现可能先于免疫缺陷出现。导致免疫紊乱的代谢性疾病可能较为罕见,但可能诊断不足。因此,在疑似代谢性疾病的患者中,如果存在反复感染或自身免疫表现,应提示免疫缺陷也可能伴随出现,应深入进行相关诊断检查。