Methods: Case 1: A 41-year-old male had suffered from empyema. His medical history revealed frequent upper respiratory tract infections and three or four times pneumonia. While IgM level was normal, IgG and IgA levels and CD4+/CD8+ T cell ratio were lower than the normal ranges.
Case 2: A 29-year-old male was referred with recurrent febrile illness, chronic diarrhea, hyperpigmented lesions on extremities, and lack of weight gain. In the past 25 years, he had recurrent episodes of sinusitis, acute otitis media or pneumonia with fever. In addition, he had been hospitalized three times due to menengitis. IgM levels were found in normal ranges, but IgG and IgA levels and CD4+/CD8+ T cell ratio were low.
Case 3: A 21-year-old male was admitted with fever, cough and ulcers on his tongue. The patient had a history of recurrent upper respiratory tract infections and tuberculosis. The laboratory investigations on admission revealed microscopic hematuria, proteinuria, Coombs' positive haemolytic anaemia, rheumatoid factor positivity, and IgA deficiency.
Case 4: A 65-year-old male was consulted due to vesiculo-ulcerative lesions on lower lip and oral mucosa and indurated yellow-white plaques on his tongue lasted for 4 years. He had a history of thymectomy because of thymoma identified first by computerized tomography (CT) after a traffic accident. Besides low levels of IgG and IgA, diminished percentages of CD19+ B cells, CD4+ T cells and CD4+/CD8+ T cell ratio invertion were found.
Results: According to ESID-PAGID criteria, the first 2 cases were diagnosed as Common Variable Immune Deficiency, third case was diagnosed as selective IgA deficiency and forth case was diagnosed as Good syndrome.
Conclusions: PID probability should be considered in recurrent, atypical and drug-resistant infections in adulthood and the patients should be referred to the clinical immunologist in time.