Ahmed Al-Bousafy 1,Abdulhamid Al-Tubuly 2, El-Hassan Dawi 1, Salem Zaroog 3, Ilka Schulze 4.
1-Department of Pediatrics and 2-Department of Microbiology & Immunology (DMI), Faculty of Medicine, University of Alfateh, Tripoli, Libya; 3-Department of Pediatrics, Tripoli Medical Center, Tripoli, Libya; and 4-Department of Pediatric Pneumology and Immunology, Center for Primary Immunodeficiency, Charite, Children’s Hospital, Berlin, Germany.
Libyan J Med, AOP: 060905 (published 11 September 2006)
Chronic granulomatous disease (CGD) is a primary immune deficiency disorder of the phagocytes. In this disorder, phagocytic cells (polymorphonuclear leukocytes and monocytes) cannot produce active oxygen metabolites, and therefore, cannot destroy the ingested intracellular bacteria. Clinically, patients with CGD usually have recurrent bacterial and fungal infections causing abscess and granuloma formation in the skin, lymph nodes and visceral organs.
In this report, we present a boy from Libya with a rare autosomal recessive trait of CGD (defect of p22-phox) who has chronic lung disease following multiple severe pneumonia attacks. The case we present suffered from bloody diarrhea since the third month of his life. He also had recurrent episodes of fever, and later, developed persistent cervical lymphadenitis and failure to gain weight. CGD is a very rare condition worldwide. It is also not recognized here in Libya, and usually not in the list of differential diagnosis for chronic pulmonary infections. We advise that pediatricians and general practitioners who treat chronic cases of lung diseases (with or without chronic diarrhea) should consider primary immunodeficiency disorders in the hope that early diagnosis and treatment may prevent chronic complications especially of the respiratory tract. Furthermore, we state that, to the best of our knowledge, this is the first documented case of CGD from Libya.
Keywords: Phagocytes, Primary Immune deficiency, Chronic Granulomatous Disease, CGD, P22-phox