To the Editor: The Jeffrey Modell Foundation in 1993 established 10 warning signs for the diagnosis of inborn errors of immunity (IEI) in children and adults where the presence of two or more signs warranted the possibility of an underlying IEI [
1]. Recurrent, deep skin or organ abscess is one of them [
1]. Pyogenic liver abscess can be a presenting clinical manifestation for patients with IEI. This retrospective cohort study analyzed 61 liver abscess (LA) patients referred to our center for IEI evaluation from January 2017 to December 2022. They were classified into isolated LA and LA with additional clinical manifestations. Secondary immunodeficiency was ruled out. Among the 58 patients presenting with isolated LA, transient lymphopenia was noted in 17% with B cell and 9% with T cell involvement. Three patients were diagnosed with: X-linked agammaglobulinemia, Mendelian susceptibility to mycobacterial diseases, and chronic granulomatous disease respectively. Transient lymphopenia is common following acute infections, especially viral infections [
2]. T cell lymphopenia has been reported previously in patients with amebic LA [
3] and we also observed the same in 9% of our patients with normal naive T cell proportion. This study revealed transient B cell lymphopenia with normal immunoglobulin levels and memory B cell proportions in 17% of isolated LA patients, a novel finding. Unfortunately, subsequent testing was not possible, except for two patients who normalized over time. However, all the patients were asymptomatic after a median follow-up of 1 y suggesting the possibility of transient B cell lymphopenia. Patients with isolated LA may show transient suppression of T or B cell counts which needs to be interpreted with caution. Such cases are less likely to have an underlying IEI. A detailed clinical history needs to be elicited to look for additional clinical features that may be a sign of an underlying IEI. …
