Epidermodysplasia Verruciformis Revealing a Late Onset Combined Immunodeficiency (LOCID): An Unusual Case
DouniaYounes *
Department of Internal Medicine, Ibn Rochd University Hospital, Casablanca, Morocco.
Israa Lassouli
Department of Internal Medicine, Ibn Rochd University Hospital, Casablanca, Morocco.
Safaa Mourabit
Department of Internal Medicine, Ibn Rochd University Hospital, Casablanca, Morocco.
Khadija Echchilali
Department of Internal Medicine, Ibn Rochd University Hospital, Casablanca, Morocco.
Mina Moudatir
Department of Internal Medicine, Ibn Rochd University Hospital, Casablanca, Morocco.
Hassan EL Kabli
Department of Internal Medicine, Ibn Rochd University Hospital, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
We report a rare association of Late Onset Combined Immunodeficiency (LOCID) with epidermodysplasia verruciformis (EV) in a 23-year-old Moroccan woman. At age 7, the patient developed thousands of small verrucae and experienced recurrent respiratory and gastrointestinal infections. A skin biopsy confirmed the diagnosis of EV. Immunological evaluation revealed low absolute counts of CD3 T cells, CD3+CD4, CD3+CD8, CD19, and CD16+CD56, with persistent lymphopenia (390-940 cells/mm³). Hypogammaglobulinemia was ruled out. The diagnosis of EV secondary to LOCID was confirmed, and the patient is currently on a monthly immunoglobulin transfusion program with favorable clinical outcomes. LOCID, a subset of Variable Common Immune Deficiency (VCID), is characterized by defects in antibody production and profound CD4 T-cell lymphopenia, distinguishing it from Common Variable Immune Deficiency (CVID). Systematic T-cell phenotyping may enhance diagnostic accuracy and therapeutic strategies, providing critical insights for genetic diagnosis and management of associated infections.
Keywords: Late onset combined immunodeficiency, epidermodysplasia verruciformis, immunoglobulin therapy, immunological disorders