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Hypogammaglobulinaemia and B cell lymphopaenia in Barth syndrome
  1. Elizabeth Kudlaty1,
  2. Neha Agnihotri1 and
  3. Amer Khojah2
  1. 1Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2Pediatrics, Umm Al-Qura University College of Medicine, Makkah, Saudi Arabia
  1. Correspondence to Dr Amer Khojah; khojah.a{at}


Barth syndrome (BTHS) is an X linked recessive disorder caused by a mutation in the tafazzin (TAZ) gene classically associated with the triad of neutropaenia and cardiac and skeletal myopathies. Here we present a case of BTHS in a 2-month-old male patient found to have a novel variant of the TAZ gene (hemizygous c.639G>A) leading to early termination of the tafazzin protein (p.Trp213Ter) with presumed loss of function. Our patient was found to have dilated cardiomyopathy, cyclic neutropaenia and growth delays, which in combination with genetic work-up confirmed the diagnosis of BTHS. He also experienced repeated bacterial and viral infections, prompting an immunological work-up which revealed persistent B cell lymphopaenia and hypogammaglobulinaemia. He ultimately required subcutaneous immunoglobulin replacement and GM-CSF for ongoing hypogammaglobulinaemia and neutropaenia. To our knowledge, this case is the first report of BTHS associated with B cell lymphopaenia and hypogammaglobulinaemia.

  • Immunology
  • Genetics
  • Paediatrics
  • Cardiovascular medicine

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  • Contributors EK: writing the case report. NA: conceptualising the case report and editing the manuscript. AK: primary care provider (ordered the labs and provided the treatment described in the case report), obtaining consent, planning and conceptualising the case report, editing the manuscript, and writing the differential diagnosis and learning points.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.