Fatal Pneumocystis jirovecii and Cytomegalovirus Infections in an Infant With Normal TRECs Count: Pitfalls of Newborn Screening for Severe Combined Immunodeficiency

Pediatr Infect Dis J. 2019 Feb;38(2):157-160. doi: 10.1097/INF.0000000000002058.

Abstract

Newborn screening for severe combined immunodeficiency using T-cell receptor excision circles allows prompt diagnosis and initiation of supportive and curative therapy thereby reducing morbidity and mortality. However, profound combined immunodeficiencies with normal numbers of nonfunctional T cells will go undetected. We present a patient with calcium release-activated calcium channel gene (ORAI1) deficiency and normal T-cell receptor excision circle numbers observed after diagnosis at the age of 14 months who suffered from disseminated fatal cytomegalovirus and Pneumocystis jirovecii infection, demonstrating a potential pitfall of the current newborn screening program.

Publication types

  • Case Reports

MeSH terms

  • Cytomegalovirus / isolation & purification*
  • Cytomegalovirus Infections / complications
  • Cytomegalovirus Infections / diagnosis*
  • Cytomegalovirus Infections / pathology
  • Diagnostic Tests, Routine / methods*
  • Fatal Outcome
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Neonatal Screening / methods*
  • Pneumocystis carinii / isolation & purification*
  • Pneumonia, Pneumocystis / complications
  • Pneumonia, Pneumocystis / diagnosis*
  • Pneumonia, Pneumocystis / pathology
  • Severe Combined Immunodeficiency / complications
  • Severe Combined Immunodeficiency / diagnosis*
  • T-Lymphocytes / pathology