Combined B-Cell and T-Cell Disorders Differential Diagnoses
- Author: Francisco J Hernandez-Ilizaliturri, MD; Chief Editor: Emmanuel C Besa, MD more...
Differential Diagnoses
- Agammaglobulinemia
- Atopic Dermatitis
- Cartilage-Hair Hypoplasia
- Complement Deficiencies
- Congenital TORCH (Toxoplasma, Rubella, Cytomegalovirus, Herpes Simplex)
- Cystic Fibrosis
- DiGeorge Syndrome
- Human Immunodeficiency Virus Infection
- Hyperimmunoglobulinemia E (Job) Syndrome
- Lymphohistiocytosis
- Lymphoproliferative Disorders
- Perinatally transmitted HIV disease
- T-Cell Disorders
- Wiskott-Aldrich Syndrome
- X-linked Immunodeficiency With Hyper IgM
Cavazzana-Calvo M, Fischer A. Gene therapy for severe combined immunodeficiency: are we there yet?. J Clin Invest. Jun 2007;117(6):1456-65. [Medline]. [Full Text].
Khiong K, Murakami M, Kitabayashi C, et al. Homeostatically proliferating CD4 T cells are involved in the pathogenesis of an Omenn syndrome murine model. J Clin Invest. May 2007;117(5):1270-81. [Medline]. [Full Text].
Cavazzana-Calvo M, Hacein-Bey S, de Saint Basile G, et al. Gene therapy of human severe combined immunodeficiency (SCID)-X1 disease. Science. Apr 28 2000;288(5466):669-72. [Medline].
Sinha S, Schwartz RA. Severe combined immunodeficiency. eMedicine from WebMD. Updated August 21, 2006. Accessed June 11, 2008. Available at http://emedicine.medscape.com/article/888072-overview.
Bonilla FA, Geha RS. 2. Update on primary immunodeficiency diseases. J Allergy Clin Immunol. Feb 2006;117(2 suppl mini-primer):S435-41. [Medline].
Bacalhau S, Freitas C, Valente R, Barata D, Neves C, Schäfer K, et al. Successful Handling of Disseminated BCG Disease in a Child with Severe Combined Immunodeficiency. Case Report Med. 2011;2011:527569. [Medline]. [Full Text].
Verbsky JW, Baker MW, Grossman WJ, Hintermeyer M, Dasu T, Bonacci B, et al. Newborn Screening for Severe Combined Immunodeficiency; The Wisconsin Experience (2008-2011). J Clin Immunol. Nov 10 2011;[Medline].
Levy J, Espanol-Boren T, Thomas C, et al. Clinical spectrum of X-linked hyper-IgM syndrome. J Pediatr. Jul 1997;131(1 pt 1):47-54. [Medline].
Zhang C, Zhang ZY, Wu JF, Tang XM, Yang XQ, Jiang LP, et al. Clinical characteristics and mutation analysis of X-linked severe combined immunodeficiency in China. World J Pediatr. Nov 21 2011;[Medline].
Ridanpaa M, van Eenennaam H, Pelin K, et al. Mutations in the RNA component of RNase MRP cause a pleiotropic human disease, cartilage-hair hypoplasia. Cell. Jan 26 2001;104(2):195-203. [Medline]. [Full Text].
Chin T, Alonazi N. B-cell and T-cell combined disorders. eMedicine from WebMD. Updated April 5, 2007. Accessed June 11, 2008. Available at http://emedicine.medscape.com/article/885493-overview.
Bertrand Y, Landais P, Friedrich W, et al. Influence of severe combined immunodeficiency phenotype on the outcome of HLA non-identical, T-cell-depleted bone marrow transplantation: a retrospective European survey from the European Group for Bone Marrow Transplantation and the European Society for Immunodeficiency. J Pediatr. Jun 1999;134(6):740-8. [Medline].
Buckley RH, Schiff SE, Schiff RI, et al. Hematopoietic stem-cell transplantation for the treatment of severe combined immunodeficiency. N Engl J Med. Feb 18 1999;340(7):508-16. [Medline]. [Full Text].
Gennery AR, Flood TJ, Abinun M, Cant AJ. Bone marrow transplantation does not correct the hyper IgE syndrome. Bone Marrow Transplant. Jun 2000;25(12):1303-5. [Medline].
Kohn DB. Adenosine deaminase gene therapy protocol revisited. Mol Ther. Feb 2002;5(2):96-7. [Medline]. [Full Text].
Casanova JL, Abel L. Primary immunodeficiencies: a field in its infancy. Science. Aug 3 2007;317(5838):617-9. [Medline].
Husain M, Grunebaum E, Naqvi A, et al. Burkitt's lymphoma in a patient with adenosine deaminase deficiency-severe combined immunodeficiency treated with polyethylene glycol-adenosine deaminase. J Pediatr. Jul 2007;151(1):93-5. [Medline].
Atluri S, Neville K, Davis M, et al. Epstein-Barr-associated leiomyomatosis and T-cell chimerism after haploidentical bone marrow transplantation for severe combined immunodeficiency disease. J Pediatr Hematol Oncol. Mar 2007;29(3):166-72. [Medline].
Chapel H, Puel A, von Bernuth H, Picard C, Casanova JL. Shigella sonnei meningitis due to interleukin-1 receptor-associated kinase-4 deficiency: first association with a primary immune deficiency. Clin Infect Dis. May 1 2005;40(9):1227-31. [Medline]. [Full Text].
Chun HJ, Zheng L, Ahmad M, et al. Pleiotropic defects in lymphocyte activation caused by caspase-8 mutations lead to human immunodeficiency. Nature. Sep 26 2002;419(6905):395-9. [Medline].
Conley ME, Notarangelo LD, Etzioni A. Diagnostic criteria for primary immunodeficiencies. Representing PAGID (Pan-American Group for Immunodeficiency) and ESID (European Society for Immunodeficiencies). Clin Immunol. Dec 1999;93(3):190-7. [Medline].
Cooper MD, Lanier LL, Conley ME, Puck JM. Immunodeficiency disorders. Hematology Am Soc Hematol Educ Program. 2003;314-30. [Medline]. [Full Text].
Creagh EM, Conroy H, Martin SJ. Caspase-activation pathways in apoptosis and immunity. Immunol Rev. Jun 2003;193:10-21. [Medline].
Fischer A, Le Deist F, Hacein-Bey-Abina S, et al. Severe combined immunodeficiency. A model disease for molecular immunology and therapy. Immunol Rev. Feb 2005;203:98-109. [Medline].
Gennery AR, Cant AJ. Diagnosis of severe combined immunodeficiency. J Clin Pathol. Mar 2001;54(3):191-5. [Medline]. [Full Text].
Hadzic N, Pagliuca A, Rela M, et al. Correction of the hyper-IgM syndrome after liver and bone marrow transplantation. N Engl J Med. Feb 3 2000;342(5):320-4. [Medline]. [Full Text].
Hermanns P, Bertuch AA, Bertin TK, et al. Consequences of mutations in the non-coding RMRP RNA in cartilage-hair hypoplasia. Hum Mol Genet. Dec 1 2005;14(23):3723-40. [Medline]. [Full Text].
Kohn DB. Gene therapy for genetic haematological disorders and immunodeficiencies. J Intern Med. Apr 2001;249(4):379-90. [Medline]. [Full Text].
Kuska B. Wiskott-Aldrich syndrome: molecular pieces slide into place. J Natl Cancer Inst. Jan 5 2000;92(1):9-11. [Medline]. [Full Text].
Notarangelo LD, Forino C, Mazzolari E. Stem cell transplantation in primary immunodeficiencies. Curr Opin Allergy Clin Immunol. Dec 2006;6(6):443-8. [Medline].
Revy P, Malivert L, de Villartay JP. Cernunnos-XLF, a recently identified non-homologous end-joining factor required for the development of the immune system. Curr Opin Allergy Clin Immunol. Dec 2006;6(6):416-20. [Medline].
Torgerson TR, Ochs HD. Regulatory T cells in primary immunodeficiency diseases. Curr Opin Allergy Clin Immunol. Dec 2007;7(6):515-21. [Medline].
Zhu Q, Watanabe C, Liu T, et al. Wiskott-Aldrich syndrome/X-linked thrombocytopenia: WASP gene mutations, protein expression, and phenotype. Blood. Oct 1 1997;90(7):2680-9. [Medline]. [Full Text].
| Pathophysiology | Cells Affected | Inheritance | Genes Involved |
| Premature cell death | T, B, NK | AR | ADA |
| Defective cytokine–dependent survival signaling | T, NK | AR γ c type-XL | JAK3, IL7RA (T cells only), γ c |
| Defective V(D)J rearrangement | T, B | AR | RAG1, RAG2, Artemis |
| Defective pre-TCR and TCR signaling | T | AR | CD3 δ, CD3 ζ, CD3 ε, CD45 |
| AR = autosomal recessive; JAK3 =Janus tyrosine kinase 3; RAG1, RAG2 = recombinase activating gene 1 and 2, respectively; TCR = T-cell receptor; XL = X-linked; V(D)J = variable diversity joining. | |||

