Introduction/Objective. Although lymphocyte immunophenotyping based on flow cytometry is a powerful tool in the diagnosis of many primary immunodeficiences (PID), there has been an increasing awareness of associated costs and the need for its reassessment as a screening tool. We present the results and diagnostic impact of immunophenotyping performed by flow cytometry in the University Children?s Hospital, Belgrade, in a series of patients referred from the Institute for Child and Youth Health Care of Vojvodina from July 2008 to July 2018. Methods. We reviewed the laboratory reports on numbers of B lymphocytes (CD19+), T lymphocytes (CD3+), natural killer (NK) cells (CD3-CD16/CD56+) and activated T cells (CD3+HLA-DR+), as well as CD4+ and CD8+ T cells in 198 children. Results Patients were grouped by stated indication into the following eight categories: hypogammaglobulinemia (34), selective IgA deficiency and/or IgG subclass deficiency (43), various infections with no immunoglobulin deficiencies (67), asthma and/or allergies with no immunoglobulin deficiencies or infections (23), known or suspected autoimmune disorders (24), and miscellaneous diagnoses not accompanied by infections (7). In total, 159 (80.3%) findings were either completely within the respective reference range or exhibited only minimal aberrations. Four patients were diagnosed with Bruton?s disease and one with Artemis immunodeficiency. Nineteen patients were given immunoglobulin substitution to control infections and/or maintain immunoglobulin G levels. Conclusion. Lymphocyte immunophenotyping aids the diagnosis of PID in selected patients. We venture some thoughts on how the usefulness of this laboratory method could be improved in real-life tertiary care pediatric hospital settings.
Introduction. Multisystem inflammatory syndrome in children (MIS-C) is a post-viral, life-threatening, inflammatory state with multisystem involvement that typically manifests 3-4 weeks after SARS-CoV-2 infection. In this article, we present the first case of MIS-C in the Institute for Child and Youth Health Care of Vojvodina at the beginning of the COVID-19 pandemic. Case outline. A previously 11-years-old healthy girl got sick two days before admission to the hospital with a fever, headache, vomiting, abdominal pain, and fatigue. She was tested positive for COVID-19 by nasopharyngeal swab PCR with positive IgM and IgG antibodies. In the further course the illness presented with prolonged fever, laboratory evidence of inflammation, multiorgan involvement such as respiratory, gastrointestinal, cardiovascular, and dermatologic. Based on Centers for Disease Control and Prevention and World Health Organization criteria the diagnosis of MIS-C was made and IVIG and methylprednisolone were introduced with favorable clinical course. Conclusion. Every prolonged and unusual febrile state, especially if it is accompanied by gastrointestinal symptoms, in a school-age child, should be investigated in the direction of recent COVID-19 infection or exposure. In a case of a positive COVID-19 history or history of exposure, the MIS-C diagnosis should be considered.
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