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Syndromic immunodeficiencies

Syndromic immunodeficiencies
Name of syndrome Primary defect Gene Immune defect Associated features
Acrodermatitis enteropathica Specific organ dysfunction SLC39A4 T, B, Ph Vesiculobullous dermatitis, alopecia, diarrhea; caused by zinc deficiency, may be associated with opportunistic infections
ARPC1B deficiency Specific organ dysfunction ARPC1B B, Ph Thrombocytopenia, vasculitis
Ataxia-telangiectasia Chromosomal instability and/or defective DNA repair ATM T, B Progressive cerebellar ataxia, telangiectasias (conjunctival), choreoathetosis
Ataxia-telangiectasia-like disorder Chromosomal instability and/or defective DNA repair MRE11A T, B Progressive cerebellar ataxia, choreoathetosis
B cell immunodeficiency, distal limb anomalies, and urogenital malformations (BILU) syndrome (Hoffman syndrome) Specific organ dysfunction ? B Limb defects, urogenital malformations
Bloom syndrome Chromosomal instability and/or defective DNA repair BLM T, B, NK Short stature, telangiectatic erythema of face, sensitivity to sunlight, pneumonia, otitis media, risk for leukemia/lymphoma
Branched chain amino acidemias Inborn errors of metabolism MUT, IVD, PCCA/PCCB T, B, Ph Methylmalonic propionic and isovaleric acidemias, acidosis, vomiting, ketosis
Cartilage-hair hypoplasia Specific organ dysfunction RMRP T, B, Ph Metaphyseal dysplasia, fine/sparse hair
CD4 lymphocytopenia Immune dysregulation ? T (+/– B, NK) Malignancy (particularly lymphomas), autoimmune disorders
CHARGE association Growth deficiency CHD7, SEMA3E T, B Coloboma, heart defect, atresia choanae, retarded growth and development, genital hypoplasia, ear anomalies/deafness
Congenital disorders of glycosylation, Types Ia, Ig, Ik Inborn errors of metabolism PMM2, ALG12, ALG1 B, Ph Decreased glycosylation hypotonia, poor growth, other organ systems may be involved depending on the type
Deletion of short arm of chromosome 4 (4p16) (Wolf-Hirschhorn syndrome) Chromosomal abnormalities of number or structure Chromosome 4p16 deletion B Growth and developmental deficiency, "Greek helmet"-like facies, microcephaly, coloboma, respiratory infections
DiGeorge syndrome Chromosomal abnormalities of number or structure Del22q11, del10p13, TBX1 T Aortic arch anomalies, hypocalcemia, thymic hypoplasia, cleft palate, facial dysmorphism
Dyskeratosis congenita (DKC) - Autosomal dominant Specific organ dysfunction TERC, TERT, TINF2 T, B, Ph Atrophy and pigmentation of skin, nail dystrophy, leukoplakia of oral mucosa
Dyskeratosis congenita (DKC) - Autosomal recessive Specific organ dysfunction NHP2, NOP10, RTEL1 T, B, Ph Atrophy and pigmentation of skin, nail dystrophy, leukoplakia of oral mucosa
Facial dysmorphism, immunodeficiency, livedo, and short stature (FILS) syndrome Specific organ dysfunction POLE1 T, B Facial dysmorphism, livedo, short stature
Familial intestinal polyatresia Specific organ dysfunction TTC7A T, B Multiple atresias from pylorus to rectum
Griscelli syndrome, type 2 Specific organ dysfunction RAB27A T, B, NK, Ph Partial albinism, frequent pyogenic infections, lymphohistiocytosis, episodic thrombocytopenia
Growth hormone pathway defects Growth deficiency BTK, STAT5B T, B, NK Defects in growth hormone synthesis or sensitivity deficiency, sinopulmonary infections
Hepatic veno-occlusive disease with immunodeficiency (VODI) Specific organ dysfunction SP110 T, B Hepatic veno-occlusive disease
Hereditary folate malabsorption Specific organ dysfunction SLC46A1 T, B Megaloblastic anemia, convulsions, movement disorder
Hoyeraal-Hreidarsson syndrome Specific organ dysfunction DKC1 T, B, Ph Cerebellar hypoplasia, absent corpus callosum, microcephaly, growth failure, pancytopenia, fungal sepsis
Hyper-IgE syndrome - Autosomal dominant (Type 1, Job syndrome) Specific organ dysfunction STAT3 T, B Eczema, scoliosis, bone fractures, joint hyperextensibility, coarse facies
Hyper-IgE syndrome - Autosomal recessive (Type 2) Specific organ dysfunction DOCK8 T, B Eczema, malignancy, CNS vasculitis/stroke
Hyper-IgE syndrome variant Specific organ dysfunction TYK2 T, B Eczema, mycobacterial infection
Hyper-IgE syndrome variant Specific organ dysfunction PGM3 T, B, Ph Eczema, developmental delay, myoclonus
Hypohidrotic/anhidrotic ectodermal dysplasia with immunodeficiency Specific organ dysfunction NEMO/NFKBIA T, B Alopecia, hypohidrosis/anhydrosis, tooth anomalies, hypogammaglobulinemia
ICF syndrome Chromosomal instability and/or defective DNA repair DNMT3B T, B Intellectual disability, chromosomal instability, facial dysmorphism; sinopulmonary, gastrointestinal, cutaneous infections
Ikaros deficiency Specific organ dysfunction IKZF1 B, Ph, NK Pancytopenia
Immunodeficiency with multiple intestinal atresia Specific organ dysfunction TTC7A T, B Multiple atresias from pylorus to rectum
Incontinentia pigmenti Specific organ dysfunction NEMO T, B, Ph Erythematous vesiculobullous eruptions, CNS involvement, swirling of macules or hyperpigmentation
Kabuki syndrome Growth deficiency KMT2D, KDM6A B Long palpebral fissures, prominent eyelashes, skeletal anomalies, congenital heart disease, increased risk of autoimmune diseases
Loeys-Dietz syndrome Specific organ dysfunction TGFBR1 B Aortic aneurysm, cleft palate, hypertelorism, eczema
Lysinuric protein intolerance Inborn errors of metabolism SLC7A7 T, B, NK, Ph Dibasic aminoaciduria, hepatomegaly, failure to thrive, severe varicella infection
Minichromosome maintenance complex component 4 (MCM4) deficiency Specific organ dysfunction MCM4 NK Growth failure, microcephaly, glucocorticoid deficiency
Missing or abnormal X chromosome (Turner syndrome; XO, isoX, ring X) Chromosomal abnormalities of number or structure X chromosome abnormality T, B Short stature, webbed neck, broad chest, ovarian dysgenesis, congenital lymphedema, pulmonary/ear infections, autoimmune disease (eg, thyroid disease, celiac disease, arthritis), gonadoblastoma (if Y chromosome material present)
MTHFD1 deficiency Specific organ dysfunction MTHFD1 T, B Megaloblastic anemia, neurologic abnormalities, hemolytic uremic syndrome
Myotonic dystrophy Specific organ dysfunction DMPK, ZNF9 B Myotonia, muscle wasting, cataract, hypogonadism, cardiac arrhythmia; caused by triplet repeat expansion
Netherton syndrome Specific organ dysfunction SPINK5 T, B, Ph Trichorrhexis invaginata (bamboo hair), ichthyosiform dermatitis, atopic diathesis, skin infections
Nijmegen breakage syndrome Chromosomal instability and/or defective DNA repair NBS1 T, B Microcephaly, intellectual disability, prenatal-onset short stature, bird-like facies, malignancy (lymphoma), sinopulmonary and urinary tract infections
OLEDAID syndrome Specific organ dysfunction NEMO B Anhidrotic ectodermal dysplasia, osteopetrosis, lymphedema
Omenn syndrome Specific organ dysfunction RAG1/RAG2/ARTEMIS T, B Erythematous dermatitis, eosinophilia, lymphadenopathy, hemophagocytosis, severe combined immunodeficiency
Postmeiotic segregation increased 2 deficiency Specific organ dysfunction PMS2 B Cancer, brain anomalies, café au lait macules
Radiosensitivity, immunodeficiency, dysmorphic features and learning difficulties (RIDDLE) syndrome Chromosomal instability and/or defective DNA repair RNF168 B Characteristic facies, learning difficulties, radiosensitivity
Roifman syndrome Growth deficiency RNU4ATAC B Short stature, spondyloepiphyseal dysplasia, developmental delay
Rubinstein-Taybi syndrome Growth deficiency EP300 T, B Broad thumbs and halluces, prominent nasal septum below ala nasi, cryptorchidism, intellectual disability
Schimke immunoosseous dysplasia Growth deficiency SMARCAL1 T, B Spondyloepiphyseal dysplasia, progressive neuropathy, episodic lymphopenia, pigmentary skin changes
Severe dermatitis, allergy, metabolic wasting (SAM) syndrome Specific organ dysfunction DSG1 B Eczema, palmoplantar keratoderma, hypotrichosis
Short-limb skeletal dysplasia with immunodeficiency Growth deficiency ADA, others T, B Short-limb skeletal dysplasia, metaphyseal dysplasia; may be associated with adenosine deaminase deficiency or Omenn syndrome; heterogeneous
Sideroblastic anemia with immunodeficiency, fevers, and developmental delay (SIFD) Specific organ dysfunction TRNT1 B Sideroblastic microcytic anemia, periodic fever, developmental delay
SPENCD1 syndrome Growth deficiency SPENCD1 T, B Spondyloenchodrodysplasia, autoimmune conditions
Transcobalamin II deficiency Specific organ dysfunction TCN2 B Transport protein for B12; severe megaloblastic anemia, leukopenia, thrombocytopenia
Trichohepatoenteric syndrome Specific organ dysfunction TTC37 B, Ph Severe infantile diarrhea, hepatic cirrhosis, Trichorrhexis nodosa, characteristic facies
Trisomy 21 (Down syndrome) Chromosomal abnormalities of number or structure Chromosome 21 T, B, Ph, NK Hypotonia, flat facies, upslanting palpebral fissures, intellectual disability, sinopulmonary infections, risk of leukemia, autoimmune thyroiditis
WHIM syndrome Specific organ dysfunction CXCR4 T, B, Ph Warts, hypogammaglobulinemia, infection, myelokathexis
Wiskott-Aldrich syndrome Specific organ dysfunction WAS T, B Severe eczema, thrombocytopenia, bloody diarrhea, recurrent infection
Wiskott-Aldrich syndrome protein-interacting protein (WIP) deficiency Specific organ dysfunction WIPF1 T, B Severe eczema, thrombocytopenia, recurrent infection
SLC39A4: solute carrier family 39 member 4; T: T cell defect; B: B cell defect; Ph: phagocyte defect; ARPC1B: actin-related protein 2/3 complex subunit 1B; ATM: ATM serine/threonine kinase; MRE11A: MRE11 homolog, double-strand break-repair nuclease; BLM: BLM RecQ-like helicase; NK: natural killer cell defect; MUT: methylmalonyl-CoA mutase; IVD: isovaleryl-CoA dehydrogenase; PCCA/PCCB: propionyl-CoA carboxylase subunit alpha/beta; RMRP: RNA component of mitochondrial RNA-processing endoribonuclease; CHARGE: coloboma, heart defect, atresia choanae, retarded growth and development, genital abnormality, and ear abnormality; CHD7: chromodomain helicase DNA-binding protein 7; SEMA3E: semaphorin 3E; PMM2: phosphomannomutase 2; ALG12: alpha-1,6-mannosyltransferase; ALG1: ALG1 chitobiosyldiphosphodolichol beta-mannosyltransferase; TBX1: T-box 1; TERC: telomerase RNA component; TERT: telomerase reverse transcriptase; TINF2: TERF1-interacting nuclear factor 2; NHP2: NHP2 ribonucleoprotein; NOP10: NOP10 ribonucleoprotein; RTEL1: regulator of telomere elongation helicase 1; POLE1: DNA polymerase epsilon, catalytic subunit; TTC7A: tetratricopeptide repeat domain 7A; RAB27A: RAB27A, member RAS oncogene family; BTK: Bruton tyrosine kinase; STAT5B: signal transducer and activator of transcription 5B; SP110: SP110 nuclear body protein; SLC46A1: solute carrier family 46 member 1; DKC1: dyskerin pseudouridine synthase 1; IgE: immunoglobulin E; STAT3: signal transducer and activator of transcription 3; DOCK8: dedicator of cytokinesis 8; CNS: central nervous system; TYK2: tyrosine kinase 2; PGM3: phosphoglucomutase 3; NEMO: NF-kappa-B essential modulator; NFKBIA: NFKB inhibitor alpha; ICF: immunodeficiency, centromeric instability, and facial anomalies; DNMT3B: DNA methyltransferase 3 beta; IKZF1: IKAROS family zinc finger 1; TTC7A: tetratricopeptide repeat domain 7A; KMT2D: lysine methyltransferase 2D; KDM6A: lysine demethylase 6A; TGFBR1: transforming growth factor beta receptor 1; SLC7A7: solute carrier family 7 member 7; MTHFD1: methylenetetrahydrofolate dehydrogenase, cyclohydrolase and formyltetrahydrofolate synthetase 1; DMPK: DM1 protein kinase; ZNF9: zinc finger protein 9; SPINK5: serine peptidase inhibitor, Kazal type 5; NBS1: Nijmegen breakage syndrome 1; OLEDAID: osteopetrosis, lymphedema, ectodermal dysplasia, anhidrotic type, and immune deficiency; RAG1: recombination activating 1; RAG2: recombination activating 2; PMS2: PMS1 homolog 2, mismatch repair system component; RNF168: ring finger protein 168; RNU4ATAC: RNA, U4atac small nuclear (U12-dependent splicing); EP300: E1A binding protein p300; SMARCAL1: SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily a-like 1; DSG1: desmoglein 1; ADA: adenosine deaminase; TRNT1: tRNA nucleotidyl transferase 1; SPENCD1: spondyloenchondrodysplasia with immune dysregulation 1; TCN2: transcobalamin 2; TTC37: tetratricopeptide repeat domain 37; WHIM: warts, hypogammaglobulinemia, infection, and myelokathexis; CXCR4: C-X-C motif chemokine receptor 4; WAS: WAS actin nucleation promoting factor; WIPF1: WAS/WASL-interacting protein family member 1.
Data from:
  1. Ming JE, Stiehm ER. Genetic syndromic immunodeficiencies with antibody defects. Immunol Allergy Clin North Am 2008; 28:715.
  2. Bonilla FA, Khan DA, Ballas ZK, et al. Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol 2015; 136:1186.
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