Multimorbid Patient with Primary Immunodeficiency. Diagnostics, Treatment

Primary immunodeficiency is a pathological condition of immune system, expressed in the absence or decrease certain parts of immune system. It was generally believed that primary immunodeficiency is a rare pathology but recent findings indicate the opposite. For that matter all types of specialists (especially family doctors) should be well informed. Primary immunodeficiency manifests with various clinical forms, like infectious, oncological, autoimmune, allergical etc. It should be well-known that primary immunodeficiency often debutes with chronic infections and diarrhea, but other sparks are also possible. As for the diagnostics, “red flags” should be taken into account, in addition to laboratory findings, such as lympho-/neutropenia, decrease in immunoglobulins and other specific tests. The therapy for primary immunodeficiency is based on substantial, vital treatment with immunoglobulins, along with prevention and treatment of comorbidities. The article discusses clinical case of an adult multimorbid patient with primary immunodeficiency, non-hereditary agammaglobulinemia with an emphasis on complexity of stating the final diagnosis in adulthood. The peculiarity of the patient is an absence of family history in immunodeficiency. He suffers from infectious (chronic bronchitis), oncological (basal cell carcinoma) and others (pancreatogenic enteropatia) clinical manifestations. It is observed, how family doctors could approach the treatment of the main pathology considering the intensification of comorbid chronic diseases. Futhermore, such patients should be managed ambulatory with full awareness of the stationary treatment and vice versa.

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