Thoracic Multidetector Computed Tomography Findings of Dedicator of Cytokinesis 8 Deficiency in Children

Abstract

Purpose: To investigate the characteristic thoracic multidetector computed tomography (MDCT) findings of dedicator of cytokinesis 8 (DOCK8) deficiency, a rare autosomal recessive form of hyperimmunoglobulin E syndrome, in children.Materials and Methods: All pediatric patients (age 18 y and below) with a known diagnosis of DOCK8 deficiency based on genetic testing who underwent thoracic MDCT studies from November 2004 to November 2020 were included. Two pediatric radiologists independently evaluated MDCT studies for the presence of thoracic abnormalities in the lung [ground-glass opacity (GGO), consolidation, pulmonary nodule, mass, cyst, and bronchiectasis], pleura (pleural effusion and pneumothorax), and mediastinum (lymphadenopathy). When a lung abnormality was present, laterality, distribution (upper, middle, and lower lung zone), and extent were also evaluated. When a pleural abnormality was identified, laterality and size of the abnormality were also assessed. When mediastinal lymphadenopathy was present, its location and size were also evaluated. Interobserver agreement between two independent reviewers was evaluated with κ statistics.Results: In all, 17 thoracic MDCT studies from 17 individual pediatric patients [5 males (29%) and 12 females (71%); mean age: 7.4 y; SD: 3.7; range: 1 to 13 y] comprised the final study population. Among 17 thoracic MDCT studies, 11 studies (65%) were performed with intravenous contrast (IV) and the remaining 6 MDCT studies (35%) were obtained without IV contrast. Bilateral bronchiectasis (11/17; 65%) with a middle lung zone predominance (8/11; 73%) was the most frequently detected lung abnormality, followed by GGO in 9/17 patients (53%). Among 11 contrastenhanced MDCT studies, the majority (9 patients, 82%) had mediastinal lymphadenopathy. There was excellent interobserver κ agreement between 2 independent reviewers for detecting abnormalities on thoracic MDCT studies (κ > 0.90). Conclusion:Children with DOCK8 deficiency have characteristic thoracic MDCT findings, including bilateral bronchiectasis with a middle lung zone predominance, GGO, and mediastinal lymphadenopathy. When these characteristic thoracic MDCT findings are detected, although rare, DOCK8 deficiency should be considered as a possible underlying diagnosis in the pediatric population.

Clinical, immunological, and genetic description of a Mexican cohort of patients with DOCK8 deficiency

“…Our series showed three cases of eosinophilic pneumonia without identifying an infectious agent; however, searching for an etiologic agent causing the eosinophilic infiltration is mandatory. To date, there are no guidelines for an adequate pulmonary follow‐up; still, we consider that annual pulmonary function tests (PFT) and biennial HRCT will allow the prompt detection of pulmonary complications that might endanger life 27,28 …”

Inmunodeficiencia combinada debida a deficiencia de DOCK8. Lo que sabemos hasta ahora

“…La presencia de sibilancias de inicio temprano y el desarrollo de asma grave es muy frecuente, por lo que ante pacientes con Def-DOCK8, el tratamiento nebulizado y la terapia de rehabilitación pulmonar son esenciales para la mejora de la calidad de vida; si bien es cierto no hay pautas que normen el adecuado seguimiento pulmonar, no es menos cierto que el seguimiento anual con pruebas de funcionamiento respiratorio (PFR) y tomografía pulmonar de alta resolución (TACAR) permitirá la detección oportuna de complicaciones pulmonares que ponen en peligro la vida. 48,49 Afectación del sistema nervioso central La afección neurológica se encuentra pobremente descrita. En las series existen informes de hipertonía muscular y parálisis facial asociadas a los hallazgos de RMN cerebral, con la presencia de displasia de mielina y atrofia cerebral.…”