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Erschienen in: Current Allergy and Asthma Reports 3/2018

01.03.2018 | Autoimmunity (TK Tarrant, Section Editor)

Granulomatous-Lymphocytic Interstitial Lung Disease in 22q11.2 Deletion Syndrome: a Case Report and Literature Review

Erschienen in: Current Allergy and Asthma Reports | Ausgabe 3/2018

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Abstract

Purpose of Review

Granulomatous-lymphocytic interstitial lung disease (GLILD) has classically been associated with common variable immune deficiency (CVID), but is increasingly being reported in other immunodeficiencies. We describe the second reported case of GLILD in a patient with 22q11.2 deletion syndrome (22q11.2DS) and review the recent literature surrounding GLILD.

Recent Findings

GLILD is characterized by granulomata and lymphoproliferation. Consensus statements and retrospective and case-control studies have better elucidated the clinicopathological and radiographic manifestations of GLILD, allowing for its differentiation from similar conditions like sarcoidosis. Gaps of knowledge remain, however, particularly regarding optimal management strategies. Combination therapies targeting T and B cell populations have recently shown favorable results.

Summary

GLILD is associated with poorer outcomes in CVID. Its recognition as a rare complication of 22q11.2DS and other immunodeficiencies therefore has important therapeutic and prognostic implications. Additional research is needed to better understand the natural history and pathogenesis of GLILD and to develop evidence-based practice guidelines.
Literatur
2.
Zurück zum Zitat •• Bates CA, Ellison MC, Lynch DA, Cool CD, Brown KK, Routes JM. Granulomatous-lymphocytic lung disease shortens survival in common variable immunodeficiency. J Allergy Clin Immunol. 2004;114(2):415–21. https://doi.org/10.1016/j.jaci.2004.05.057. First coined the term GLILD in patients with CVID and reported that a diagnosis of GLILD is associated with increased morbidity and early mortality. CrossRefPubMed •• Bates CA, Ellison MC, Lynch DA, Cool CD, Brown KK, Routes JM. Granulomatous-lymphocytic lung disease shortens survival in common variable immunodeficiency. J Allergy Clin Immunol. 2004;114(2):415–21. https://​doi.​org/​10.​1016/​j.​jaci.​2004.​05.​057. First coined the term GLILD in patients with CVID and reported that a diagnosis of GLILD is associated with increased morbidity and early mortality. CrossRefPubMed
3.
Zurück zum Zitat De Dios JA, Javaid AA, Ballesteros E, Metersky ML. An 18-year-old woman with Kabuki syndrome, immunoglobulin deficiency and granulomatous lymphocytic interstitial lung disease. Conn Med. 2012;76(1):15–8.PubMed De Dios JA, Javaid AA, Ballesteros E, Metersky ML. An 18-year-old woman with Kabuki syndrome, immunoglobulin deficiency and granulomatous lymphocytic interstitial lung disease. Conn Med. 2012;76(1):15–8.PubMed
10.
Zurück zum Zitat • Mather MW, Hayhurst H, Bacon CM, Cole TS, Pan-Hammarstrom Q, Misbah S, et al. Mutation of TNFRSF13B in a child with 22q11 deletion syndrome associated with granulomatous lymphoproliferation. J Allergy Clin Immunol. 2015;135(2):559–61. https://doi.org/10.1016/j.jaci.2014.07.025. The first and only previously published report of GLILD in a patient with 22q11.2DS. CrossRefPubMed • Mather MW, Hayhurst H, Bacon CM, Cole TS, Pan-Hammarstrom Q, Misbah S, et al. Mutation of TNFRSF13B in a child with 22q11 deletion syndrome associated with granulomatous lymphoproliferation. J Allergy Clin Immunol. 2015;135(2):559–61. https://​doi.​org/​10.​1016/​j.​jaci.​2014.​07.​025. The first and only previously published report of GLILD in a patient with 22q11.2DS. CrossRefPubMed
11.
Zurück zum Zitat •• Hurst JR, Verma N, Lowe D, Baxendale HE, Jolles S, Kelleher P, et al. British Lung Foundation/United Kingdom Primary Immunodeficiency Network consensus statement on the definition, diagnosis, and management of granulomatous-lymphocytic interstitial lung disease in common variable immunodeficiency disorders. J Allergy Clin Immunol Pract. 2017;5(4):938–45. https://doi.org/10.1016/j.jaip.2017.01.021. These consensus statements represent the largest collection of shared clinical experience in the multi-disciplinary care of patients with GLILD and are the first step towards development of practice guidelines. CrossRefPubMed •• Hurst JR, Verma N, Lowe D, Baxendale HE, Jolles S, Kelleher P, et al. British Lung Foundation/United Kingdom Primary Immunodeficiency Network consensus statement on the definition, diagnosis, and management of granulomatous-lymphocytic interstitial lung disease in common variable immunodeficiency disorders. J Allergy Clin Immunol Pract. 2017;5(4):938–45. https://​doi.​org/​10.​1016/​j.​jaip.​2017.​01.​021. These consensus statements represent the largest collection of shared clinical experience in the multi-disciplinary care of patients with GLILD and are the first step towards development of practice guidelines. CrossRefPubMed
12.
Zurück zum Zitat • Liebow AA, Carrington CB. Diffuse pulmonary lymphoreticular infiltrations associated with dysproteinemia. Med Clin North Am. 1973;57(3):809–43. One of the first reports of the lymphoproliferative features seen in GLILD in a patient with dysproteinemia. CrossRefPubMed • Liebow AA, Carrington CB. Diffuse pulmonary lymphoreticular infiltrations associated with dysproteinemia. Med Clin North Am. 1973;57(3):809–43. One of the first reports of the lymphoproliferative features seen in GLILD in a patient with dysproteinemia. CrossRefPubMed
15.
Zurück zum Zitat • Chase NM, Verbsky JW, Hintermeyer MK, Waukau JK, Tomita-Mitchell A, Casper JT, et al. Use of combination chemotherapy for treatment of granulomatous and lymphocytic interstitial lung disease (GLILD) in patients with common variable immunodeficiency (CVID). J Clin Immunol. 2013;33(1):30–9. https://doi.org/10.1007/s10875-012-9755-3. This retrospective chart review of 7 patients with GLILD that were unresponsive to conventional therapy with corticosteroids demonstrated the utility of combination chemotherapy treatment. CrossRefPubMed • Chase NM, Verbsky JW, Hintermeyer MK, Waukau JK, Tomita-Mitchell A, Casper JT, et al. Use of combination chemotherapy for treatment of granulomatous and lymphocytic interstitial lung disease (GLILD) in patients with common variable immunodeficiency (CVID). J Clin Immunol. 2013;33(1):30–9. https://​doi.​org/​10.​1007/​s10875-012-9755-3. This retrospective chart review of 7 patients with GLILD that were unresponsive to conventional therapy with corticosteroids demonstrated the utility of combination chemotherapy treatment. CrossRefPubMed
22.
Zurück zum Zitat • Rao N, Mackinnon AC, Routes JM. Granulomatous and lymphocytic interstitial lung disease: a spectrum of pulmonary histopathologic lesions in common variable immunodeficiency—histologic and immunohistochemical analyses of 16 cases. Hum Pathol. 2015;46(9):1306–14. https://doi.org/10.1016/j.humpath.2015.05.011. Characterized the spectrum of histopathologic and immunohistochemical features of GLILD through a retrospective chart review of 16 cases and highlighted the absence of FOXP3+ T regulatory cells in lung biopsies of patients with GLILD. CrossRefPubMedPubMedCentral • Rao N, Mackinnon AC, Routes JM. Granulomatous and lymphocytic interstitial lung disease: a spectrum of pulmonary histopathologic lesions in common variable immunodeficiency—histologic and immunohistochemical analyses of 16 cases. Hum Pathol. 2015;46(9):1306–14. https://​doi.​org/​10.​1016/​j.​humpath.​2015.​05.​011. Characterized the spectrum of histopathologic and immunohistochemical features of GLILD through a retrospective chart review of 16 cases and highlighted the absence of FOXP3+ T regulatory cells in lung biopsies of patients with GLILD. CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat • Bouvry D, Mouthon L, Brillet PY, Kambouchner M, Ducroix JP, Cottin V et al. Granulomatosis-associated common variable immunodeficiency disorder: a case-control study versus sarcoidosis. Eur Respir J. 2013;41(1):115–22. doi:https://doi.org/10.1183/09031936.00189011. The clinical, radiographic, and histologic features as well as the clinical course of GLILD and sarcoidosis are compared and contrasted in this case-control study. • Bouvry D, Mouthon L, Brillet PY, Kambouchner M, Ducroix JP, Cottin V et al. Granulomatosis-associated common variable immunodeficiency disorder: a case-control study versus sarcoidosis. Eur Respir J. 2013;41(1):115–22. doi:https://​doi.​org/​10.​1183/​09031936.​00189011. The clinical, radiographic, and histologic features as well as the clinical course of GLILD and sarcoidosis are compared and contrasted in this case-control study.
29.
Zurück zum Zitat Gottlieb JE, Israel HL, Steiner RM, Triolo J, Patrick H. Outcome in sarcoidosis. The relationship of relapse to corticosteroid therapy. Chest. 1997;111(3):623–31.CrossRefPubMed Gottlieb JE, Israel HL, Steiner RM, Triolo J, Patrick H. Outcome in sarcoidosis. The relationship of relapse to corticosteroid therapy. Chest. 1997;111(3):623–31.CrossRefPubMed
31.
Zurück zum Zitat Kohler PF, Cook RD, Brown WR, Manguso RL. Common variable hypogammaglobulinemia with T-cell nodular lymphoid interstitial pneumonitis and B-cell nodular lymphoid hyperplasia: different lymphocyte populations with a similar response to prednisone therapy. J Allergy Clin Immunol. 1982;70(4):299–305. https://doi.org/10.1016/0091-6749(82)90066-5.CrossRefPubMed Kohler PF, Cook RD, Brown WR, Manguso RL. Common variable hypogammaglobulinemia with T-cell nodular lymphoid interstitial pneumonitis and B-cell nodular lymphoid hyperplasia: different lymphocyte populations with a similar response to prednisone therapy. J Allergy Clin Immunol. 1982;70(4):299–305. https://​doi.​org/​10.​1016/​0091-6749(82)90066-5.CrossRefPubMed
32.
Zurück zum Zitat Wehr C, Kivioja T, Schmitt C, Ferry B, Witte T, Eren E, Vlkova M., Hernandez M., Detkova D., Bos P.R., Poerksen G., von Bernuth H., Baumann U., Goldacker S., Gutenberger S., Schlesier M., Bergeron-van der Cruyssen F., le Garff M., Debre P., Jacobs R., Jones J., Bateman E., Litzman J., van Hagen P.M., Plebani A., Schmidt R.E., Thon V., Quinti I., Espanol T., Webster A.D., Chapel H., Vihinen M., Oksenhendler E., Peter H.H., Warnatz K. The EUROclass trial: defining subgroups in common variable immunodeficiency. Blood 2008;111(1):77–85. doi:https://doi.org/10.1182/blood-2007-06-091744, 1. Wehr C, Kivioja T, Schmitt C, Ferry B, Witte T, Eren E, Vlkova M., Hernandez M., Detkova D., Bos P.R., Poerksen G., von Bernuth H., Baumann U., Goldacker S., Gutenberger S., Schlesier M., Bergeron-van der Cruyssen F., le Garff M., Debre P., Jacobs R., Jones J., Bateman E., Litzman J., van Hagen P.M., Plebani A., Schmidt R.E., Thon V., Quinti I., Espanol T., Webster A.D., Chapel H., Vihinen M., Oksenhendler E., Peter H.H., Warnatz K. The EUROclass trial: defining subgroups in common variable immunodeficiency. Blood 2008;111(1):77–85. doi:https://​doi.​org/​10.​1182/​blood-2007-06-091744, 1.
33.
Zurück zum Zitat Mullighan CG, Fanning GC, Chapel HM, Welsh KI. TNF and lymphotoxin-alpha polymorphisms associated with common variable immunodeficiency: role in the pathogenesis of granulomatous disease. J Immunol. 1997;159(12):6236–41.PubMed Mullighan CG, Fanning GC, Chapel HM, Welsh KI. TNF and lymphotoxin-alpha polymorphisms associated with common variable immunodeficiency: role in the pathogenesis of granulomatous disease. J Immunol. 1997;159(12):6236–41.PubMed
41.
Zurück zum Zitat • Jolles S, Carne E, Brouns M, El-Shanawany T, Williams P, Marshall C, et al. FDG PET-CT imaging of therapeutic response in granulomatous lymphocytic interstitial lung disease (GLILD) in common variable immunodeficiency (CVID). Clin Exp Immunol. 2017;187(1):138–45. https://doi.org/10.1111/cei.12856. This case report suggests that FDG PET-CT imaging may prove to be a useful imaging modality that combines both functional and anatomical information in the long-term monitoring of patients with GLILD. CrossRefPubMed • Jolles S, Carne E, Brouns M, El-Shanawany T, Williams P, Marshall C, et al. FDG PET-CT imaging of therapeutic response in granulomatous lymphocytic interstitial lung disease (GLILD) in common variable immunodeficiency (CVID). Clin Exp Immunol. 2017;187(1):138–45. https://​doi.​org/​10.​1111/​cei.​12856. This case report suggests that FDG PET-CT imaging may prove to be a useful imaging modality that combines both functional and anatomical information in the long-term monitoring of patients with GLILD. CrossRefPubMed
42.
Zurück zum Zitat • Tashtoush B, Memarpour R, Ramirez J, Bejarano P, Mehta J. Granulomatous-lymphocytic interstitial lung disease as the first manifestation of common variable immunodeficiency. Clin Respir J. 2016;12(1):337–43. https://doi.org/10.1111/crj.12511. Highlights the need to maintain a high index of suspicion for GLILD as this may be the first manifestation of an underlying immune deficiency. CrossRefPubMed • Tashtoush B, Memarpour R, Ramirez J, Bejarano P, Mehta J. Granulomatous-lymphocytic interstitial lung disease as the first manifestation of common variable immunodeficiency. Clin Respir J. 2016;12(1):337–43. https://​doi.​org/​10.​1111/​crj.​12511. Highlights the need to maintain a high index of suspicion for GLILD as this may be the first manifestation of an underlying immune deficiency. CrossRefPubMed
Metadaten
Titel
Granulomatous-Lymphocytic Interstitial Lung Disease in 22q11.2 Deletion Syndrome: a Case Report and Literature Review
Publikationsdatum
01.03.2018
Erschienen in
Current Allergy and Asthma Reports / Ausgabe 3/2018
Print ISSN: 1529-7322
Elektronische ISSN: 1534-6315
DOI
https://doi.org/10.1007/s11882-018-0769-7

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