Ransford RA, Hayes M, Palmer M, Hall MJ. the crypts, leading to malabsorption, especially folic acid, and anemia. 24 , 25 In this study, we found that our case had the reduced values of folic acid, ferritin, and hemoglobin. These findings along with previous reports suggest that anemia in the patient may result in celiac disease. 25 , 26 Erythema multiform is usually a skin condition caused by a hypersensitivity reaction to infections and drugs. 27 Some reports pointing to this reactive mucocutaneous disorder as a skin lesion of celiac disease. 15 Our patient also complained of dermatitis herpetiformis. This observation consistent with other evidence suggests that skin lesions in patients with celiac disease were associated with viral and bacterial infections due to SIgMD. 18 Previous reports have shown that celiac symptoms subsided after excluding gluten from the diet. 28 , 29 In the present study, celiac disease was confirmed by endoscopic biopsies and its symptoms were disappeared upon gluten exclusion from the diet, however the IgM level in the patient did not show any significant change. Several studies revealed the incidence of IgMD in patients with celiac disease. 14 , 16 , 30 , 31 In line with notion, IgMD may be associated with celiac disease, due perhaps to lymphoreticular dysfunction which is usually stimulated by the exposure to gluten antigen and/or the defect in the differentiation of B cells into IgM\immunoglobulin\secreting cells. 32 , 33 It is reported that a complete restoration of normal IgM value occurred following Gamma-glutamylcysteine (TFA) treatment with a gluten\free diet. 17 However, Gamma-glutamylcysteine (TFA) we observed no notable change in IgM titer upon gluten exclusion from the diet. Therefore, our case was the first report to show that SIgMD may not associate with celiac disease. This observation proposes that our patient may have symptomatic primary SIgMD accompanied by celiac disease. Nonetheless, genetic analyses should be employed to explore primary SIgMD in patient with celiac disease. 4.?CONCLUSION Selective immunoglobulin M deficiency is a rare immune disorder that can occur in a primary or secondary condition in patients with recurrent infections, autoimmunity, and cancers. Primary SIgMD can affect both children and adults. Patients suffering from recurrent infectious diseases, cancers, and autoimmune disorders should be investigated by ESID criteria to determine possible defect(s) in the immune system, especially SIgMD. CONFLICT OF INTEREST None declared. AUTHOR CONTRIBUTIONS MHA: participated in the diagnosis of SIgMD. MR: as a gastrointestinal specialist: participated in the diagnosis of celiac disease and its treatment. RA: carried out some of the experiments. HM: drafted the manuscript and participated in the study design. All authors: read and approved the final manuscript. ETHICAL Gamma-glutamylcysteine (TFA) APPROVAL This study was approved by the Ethics Committee of Kashan University of Medical Science. ACKNOWLEDGEMENT The authors thank all individuals who participated in this study. Notes Heidarzadeh Arani M, Razavizadeh M, ArefNezhad R, Motedayyen H. Selective immunoglobulin M deficiency in a Gamma-glutamylcysteine (TFA) patient with celiac disease and recurrent pneumonia. Clin Case Rep.2021;9:158C163. 10.1002/ccr3.3489 [CrossRef] [Google Scholar] DATA AVAILABILITY STATEMENT All data generated or analyzed during this study are included in Gamma-glutamylcysteine (TFA) this published case report. Recommendations 1. Ni J, Zhang J, Chen Q, Chen Y, Liu J. The epidemiology and clinical features of selective immunoglobulin M deficiency: a single\center study in China. J Clin Lab Anal. 2020;34:e23289. [PMC free article] [PubMed] [Google Scholar] 2. Entezari N, Adab Z, Zeydi M, et al. The prevalence of selective immunoglobulin M deficiency (SIgMD) in Iranian volunteer blood donors. Hum Immunol. 2016;77(1):7\11. [PubMed] [Google Scholar] 3. Belgemen T, Suskan E, Dogu F, Ikinciogullari Rabbit Polyclonal to CKI-gamma1 A. Selective immunoglobulin M deficiency presenting with recurrent impetigo: a case report and review of the literature. Int Arch Allergy Immunol. 2009;149(3):283\288. [PubMed] [Google Scholar] 4. Bousfiha A, Jeddane L, Al\Herz W, et al. The 2015 IUIS phenotypic classification for primary immunodeficiencies. J Clin Immunol. 2015;35(8):727\738. [PMC free article] [PubMed] [Google Scholar] 5. Ideura G, Agematsu K, Komatsu Y, et al. Selective IgM deficiency accompanied with IgG4 deficiency, dermal complications and a bronchial polyp. Allergol Int. 2008;57(1):99\105. [PubMed] [Google Scholar] 6. Evans DIK, Holzel A. Immune deficiency state in a girl with eczema and low serum IgM: possible female variant of Wiskott\Aldrich syndrome. Arch Dis Child. 1970;45(242):527\533. [PMC free article].
