Immunoglobulin A deficiency, HPV and Oral Cancer

Background: Selective IgA deficiency is the most common primary immunodeficiency. Serum IgA level lower than 7 mg / dl  is considered selective IgA deficiency. Most people with selective IgA deficiency are asymptomatic, with incidental findings. Others may present recurrent respiratory infections, allergic symptoms, other infections and autoimmune diseases. It represents a genetically heterogeneous group of abnormalities. We report two cases of IgA-deficiency, HPV, and cancer, which required oral mucosa and tongue surgery.

Methods:
Case I
Female patient, 30 years old.
Medical history: vaginal HPV and Herpes. No promiscuous conduct.
Complaint: recurrent infections.
Physical exam: oral white lesions are observed.
Laboratory findings: serum immunoglobulin A: lower than 7 mg%, secretory immunoglobulin A: lower than 1 mg%. Both exams were repeated and determinations showed low values. Cytology - Glucose - serum protein electrophoresis - Ig G - Ig M - CD3 - CD4 - CD8 - CD19 - CD56 all determinations showed normal values. HIV  I /II: negative.
Biopsy of oral mucosa with the following report: severe dysplasia and intraepithelial carcinoma. Signs of HPV. Surgery was performed on oral mucosa with the following pathology report: moderately differentiated squamous cell carcinoma. Microscopic, morphological changes related to cytopathogenic viral effects. The patient presented good evolution.

Case II:

Female patient 40 years of age.
Medical history: HPV and genital herpes. No promiscuous conduct.
Complaint: leukoplakia in tongue edges.
Physical examination: oral white lesions.
Laboratory serum immunoglobulin A: value obtained: lower than 7 mg%. Cytology  - Glucose - serum protein electrophoresis - Ig G - Ig M - CD3 - CD4 - CD8 - CD19 - CD56 with normal values.  HIV I / II: negative.
Surgery was performed in tongue and regional lymph node. Tongue Pathology: moderately differentiated squamous cell carcinoma with negative edges. HPV (+) PCR.

Conclusion: We report on the possible association between selective IgA deficiency - HPV - Cancer which has not been previously reported in time. We suggest further screening of these possible associations and detailed monitoring of these patients.