Delayed-type Hypersensitivity Differential Diagnoses

Updated: Sep 26, 2018
  • Author: Harumi Jyonouchi, MD; Chief Editor: Russell W Steele, MD  more...
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DDx

Diagnostic Considerations

Consider primary T-cell immunodeficiency, including severe combined immunodeficiency (SCID), when anergy is present. Other well-recognized primary immunodeficiency diseases with anergy include Wiskott-Aldrich syndrome, DiGeorge syndrome, ataxia telangiectasia, and other chromosomal breakage disorders.

Exclude malnutrition, overwhelming infection, and immunosuppression with corticosteroids and other drugs. Certain malignancies, such as Hodgkin disease, are associated with anergy. Consider rheumatologic disease, especially systemic lupus erythematosus and sarcoidosis as a cause of anergy in specific clinical situations. Also consider temporary immunosuppression following MMR vaccination (< 3 wk) in young infants

Mutations that effect responses to interferon (IFN)-γ or its production include IFNGR1, IFNGR2, STAT-1, IL12P4, and IL12RB1. As a result, these patients may manifest altered (often excessive) DTH skin test reactivity.

In patients with autosomal dominant hyper IgE syndrome caused by STAT3 mutation or DOCK8 deficiency, DTH responses may be attenuated due to impaired Th17 cell development.

Differential Diagnoses