Background The natural history of anti-interferon-γ (IFN-γ) autoantibody-associated immunodeficiency syndrome is not well understood. Methods Data of 74 patients with anti-IFN-γ autoantibodies at Srinagarind Hospital, Thailand, were collected annually (median follow-up duration, 7.5 years). Annual data for 19 patients and initial data for 4 patients with anti-IFN-γ autoantibodies at the US National Institutes of Health were collected (median follow-up duration, 4.5 years). Anti-IFN-γ autoantibody levels were measured in plasma samples. Results Ninety-one percent of US patients were of Southeast Asian descent; there was a stronger female predominance (91%) in US than Thai (64%) patients. Mycobacterium abscessus (34%) and Mycobacterium avium complex (83%) were the most common nontuberculous mycobacteria in Thailand and the United States, respectively. Skin infections were more common in Thailand (P = .001), whereas bone (P < .0001), lung (P = .002), and central nervous system (P = .03) infections were more common in the United States. Twenty-four percent of Thai patients died, most from infections. None of the 19 US patients with follow-up data died. Anti-IFN-γ autoantibody levels decreased over time in Thailand (P < .001) and the United States (P = .017), with either cyclophosphamide (P = .01) or rituximab therapy (P = .001). Conclusions Patients with anti-IFN-γ autoantibodies in Thailand and the United States had distinct demographic and clinical features. While titers generally decreased with time, anti-IFN-γ autoantibody disease had a chronic clinical course with persistent infections and death. Close long-term surveillance for new infections is recommended.

Importance While poorer populations have more eye problems, it is not known if they face greater difficulty obtaining eye care appointments. Objective To compare rates of obtaining eye care appointments and appointment wait times for those with Medicaid and private insurance. Design In this prospective observational study, researchers telephoned a randomly selected sample of vision care providers in Michigan and Maryland stratified by neighborhood (urban vs. rural) and provider type (ophthalmologist vs. optometrist) to request the first available appointment. Appointments were sought for an adult needing a diabetic eye exam and a child requesting a routine eye exam for a failed vision screening. Researchers called each practice twice, approximately 2–7 days apart, once requesting an appointment for a patient with Medicaid, and the other for a patient with BlueCross BlueShield (BCBS), and asked if 1) the insurance was accepted, and if so, 2) when the earliest available appointment was. Setting Eye clinics throughout Maryland and Michigan. Participants Random sample of 330 ophthalmology and optometry practices. Main Outcomes and Measures Rate of successfully made appointments and mean wait time for the first available appointment. Results A total of 330 eye care providers were contacted. The sample consisted of ophthalmologists (50%) and optometrists (50%) located in Maryland (53%) and Michigan (47%). The rates of successfully obtaining appointments among callers said to have Medicaid and BCBS were 62% [56%,67%] and 79% [75%,84%] (p<0.001), respectively, for adults, and 45% [40%,51%] and 63% [57%,68%] (p<0.001), respectively, for children. Mean wait time did not vary significantly between BCBS and Medicaid for both adult and child. Factors associated with decreased odds of obtaining an appointment for adults and children included Medicaid insurance, appointment with an ophthalmologist and practice location in Maryland. Conclusions and Relevance Callers were less successful in trying to obtain eye care appointments with Medicaid than with BCBS, suggesting a disparity in access to eye care based on insurance status, though confounding factors may have also contributed to this finding. Improving access to eye care professionals for those with Medicaid may improve health outcomes and decrease healthcare spending in the long term.

Patients presenting with extraocular MMP are at risk for developing ocular MMP, and all MMP patients are at risk for developing secondary extraocular MMP locations, although the rates were low.

Interferon-γ autoantibodies increase the risk of disseminated nontuberculous mycobacterial infections. Addition of rituximab to antibiotics accelerates and improves outcomes, but refractory infections can occur due to persistent production of autoantibodies. We combined bortezomib with rituximab to reduce autoantibodies leading to clinical and radiographic improvement in infection.