title: [X-linked agammaglobulinemia: experience in a Portuguese hospital].
abstract: BACKGROUND
  X-Linked agammaglobulinemia (XLA) is characterized by an arrest of B cell differentiation, leading to recurrent bacterial infections. Lifelong immunoglobulin replacement therapy (IRT) is indicated to prevent infections and their complications.
  
  
  METHODS
  A retrospective study of patients with XLA followed in a level three hospital was performed; data was collected retrospectively by review of clinical files.
  
  
  RESULTS
  XLA was diagnosed in 9 children. One (11%) had a positive family history with a prenatal diagnosis. Infection was the clinical presentation in all the others (89%), at an average age of 13 months; diagnosis was established at a mean age of 3.4 years. Acute otitis media (7/9) and pneumonia (5/9) were the most frequently observed. Seven (78%) presented serum immunoglobulin G (IgG) levels below 200mg/dL and all of them had CD19(+) B cells below 2%. Neutropenia was present at diagnosis in three patients (33%). Bruton tyrosine kinase (BTK) mutations were identified in all cases. Intravenous IRT was initiated, switched later to subcutaneous administration, in all. The mean time of follow-up was 10.7 years with cumulative time of 97 years. Eight children (89%) achieved IgG serum levels above 800 mg/dL. One presented lower values due to renal loss. No deaths occurred. After diagnosis the most frequent infections were acute otitis media (6/9). In spite of stable adequate IgG levels on IRT, two patients developed bronchiectasis.
  
  
  CONCLUSIONS
  XLA overall prognosis is good, as long as patients have an early and adequate treatment. However, bronchiectasis can occur even on adequate immunoglobulin replacement therapy.
authors.affiliation: Unidade de Infecciologia Pediátrica e Imunodeficiências, Serviço de Pediatria, Centro Hospitalar Porto, Oporto, Portugal. Electronic address: xanofernandes@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Fernandes
authors.affiliation: Unidade de Infecciologia Pediátrica e Imunodeficiências, Serviço de Pediatria, Centro Hospitalar Porto, Oporto, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Guedes
authors.affiliation: Unidade de Infecciologia Pediátrica e Imunodeficiências, Serviço de Pediatria, Centro Hospitalar Porto, Oporto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Vasconcelos
authors.affiliation: Unidade de Infecciologia Pediátrica e Imunodeficiências, Serviço de Pediatria, Centro Hospitalar Porto, Oporto, Portugal.
authors.forename: E
authors.initials: E
authors.lastname: Neves
authors.affiliation: Departamento de Genética, Faculdade de Medicina da Universidade do Porto, Oporto, Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Fernandes
authors.affiliation: Unidade de Infecciologia Pediátrica e Imunodeficiências, Serviço de Pediatria, Centro Hospitalar Porto, Oporto, Portugal.
authors.forename: L
authors.initials: L
authors.lastname: Marques
mesh_terms: D000361:Agammaglobulinemia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D040181:Genetic Diseases, X-Linked / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D006761:Hospitals; D006801:Humans; D007223:Infant; D008297:Male; D011174:Portugal; D012189:Retrospective Studies
keywords: Agammaglobulinemia; Agammaglobulinemia ligada al cromosoma X; Immunoglobulins; Infección; Infection; Inmunoglobulinas; X linked agammaglobulinemia