Goldenhar syndrome: a cause of secondary immunodeficiency?
1 Section of Immunology, Allergy and Rheumatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
2 Texas Children’s Hospital, Houston, TX, USA
3 Medical Education Department, Driscoll Children’s Hospital, Corpus Christi, TX, USA
4 Department of Pediatric Radiology, Baylor College of Medicine, Houston, TX, USA
5 Section of Allergy and Immunology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Allergy, Asthma & Clinical Immunology 2012, 8:10 doi:10.1186/1710-1492-8-10Published: 2 July 2012
Goldenhar syndrome (GS) results from an aberrant development of the 1st and 2nd branchial arches. There is a wide range of clinical manifestations, the most common being microtia, hemifacial microsomia, epibulbar dermoids and vertebral malformations. We present two cases of GS and secondary immunodeficiency due to anatomical defects characteristic of this disorder. Case 1 (3-year-old female) averaged 6 episodes of sinusitis and otitis media per year. Case 2 (7-year-old female) also had recurrent otitis media, an episode of bacterial pneumonia, and 2 episodes of bacterial meningitis. Their immune evaluation included a complete blood count with differential, serum immunoglobulin levels and specific antibody concentrations, lymphocyte phenotyping, and mitogen and antigen responses, the results of which were all within normal ranges. Both children demonstrated major structural abnormalities of the inner and middle ear structures, retention of fluid in mastoid air cells, and chronic sinusitis by computed tomography. These two cases illustrate how a genetically-associated deviation of the middle ear cleft can cause recurrent infections and chronic inflammation of the middle ear and adjacent sinuses, even meninges, leading to a greatly reduced quality of life for the child and parents.