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Femoroacetabular impingement syndrome — MRCP Part 1 MCQ

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HardHip and GroinFemoroacetabular impingement syndromeMRCP Part 1

A previously healthy 45-year-old woman from Thailand develops disseminated Mycobacterium avium infection and Talaromyces marneffei lymphadenitis. HIV testing, lymphocyte subsets and immunoglobulins are unremarkable. Which investigation is most likely to identify the acquired immune defect?

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Correct answer: E — Neutralising anti-interferon-gamma autoantibodies

The best answer is “Neutralising anti-interferon-gamma autoantibodies”. This adult-onset syndrome in a person from Southeast Asia is strongly associated with high-titre neutralising anti-interferon-gamma autoantibodies. They block macrophage activation and predispose to disseminated intracellular pathogens, especially nontuberculous mycobacteria, Talaromyces and Salmonella. Anti-GM-CSF antibodies are linked more strongly to pulmonary alveolar proteinosis and cryptococcosis. Germline IL-12/IFN-gamma pathway defects generally present much earlier, while ADA deficiency causes severe combined immunodeficiency.

Reference: Minireview: Insights into anti-interferon-gamma autoantibodies: https://pmc.ncbi.nlm.nih.gov/articles/PMC8719035/