Musculoskeletal Medicine and PainCASE REPORT

Structural abnormalities and osteopathic considerations in primary immunodeficiencies

Marija J. Rowane, DO; Meghan A. Callahan, BS; Jason E. Schend, DO; Michael P. Rowane, DO, MS, FAAFP, FAAO; and Robert W. Hostoffer, DO, LhD, MSMEd, FACOP, FAAP, FCCP, FACOI
Notes and Affiliations
Notes and Affiliations

Received: July 5, 2022

Accepted: January 4, 2023

Published: January 25, 2023

  • Marija J. Rowane, DO, 

    Pediatric Resident, Children’s Hospital of St. Francis at Oklahoma State University, Tulsa, OK, USA

  • Meghan A. Callahan, BS, 

    Lake Erie College of Osteopathic Medicine – Elmira, Elmira, NY, USA

  • Jason E. Schend, DO, 

    Allergist, Shoreline Allergy, Muskegon, MI, USA

  • Michael P. Rowane, DO, MS, FAAFP, FAAO, 

    Professor of Family Medicine and Osteopathic Manipulative Medicine, Associate Dean of Clinical Education, Lake Erie College of Osteopathic Medicine, Erie, PA, USA

  • Robert W. Hostoffer, DO, LhD, MSMEd, FACOP, FAAP, FCCP, FACOI, 

    Program Director, Osteopathic Pediatric and Adult Allergy/Immunology Fellowship, Associate Professor of Pediatrics Case Western Reserve University, Cleveland, OH, USA

J Osteopath Med; 123(4): 195-199

Structural skeletal abnormalities are associated with primary immunodeficient (PID) patients. These abnormalities have not been well studied in PID with reference to osteopathic medicine tenets. Osteopathic structural examinations of PID patients with respect to these tenets and the diagnosis of somatic dysfunctions preventing the free flow of lymph fluids back into the circulation and the disruption of the skeletal microenvironment may have an impact on the status of the immune system in patients with a PID. A standardized evaluation was conducted in a patient with a phosphatidylinositol 3-kinase regulatory subunit 1 (PIK3R1) mutation who presented with skeletal abnormalities. A literature review was also conducted to determine the breadth of other PIDs with structural irregularities. Osteopathic structural clinical examinations (OSCEs) were performed by an osteopathic medical student, fellow, and attending after receiving informed consent from the patient. The findings were collected regionally noting severity, tissue texture changes, asymmetry, altered range of motion (ROM), and tenderness according to DO-Touch.NET physical examination and treatment form. A literature review was conducted utilizing various search engines and the textbook, Stiehm’s Immune Deficiencies, 4th edition. The significant findings found from the patient were right sidebending rotation cranial strain pattern with decreased left temporal bone motion, temporomandibular joint crepitus, and right deviation upon mandibular opening. The thoracolumbar region revealed tissue tenderness and restricted psoas ROM. Bilateral sacroiliac joint tenderness, right superior sheering, and anterior innominate rotation, along with left-on-left sacral flexion, were associated with valgus knees. The literature search showed multiple other PIDs outside of PIK3R1 that have associated skeletal and structural abnormalities. Irregular skeletal features found in immunodeficient patients may have an additive defect on the immunological responses due to somatic dysfunction impinging on the lymphatic flow to the central circulation. Other different immunodeficient patients suffer from boney structural abnormalities, which may lead to further immune hindrance caused by impingement of flow as well as bone marrow microenvironment impact on the peripheral immunological output. We present the first osteopathic examination with detailed findings of somatic dysfunction in a patient with PID. Future studies on PID patients should require more attention to structure and function, as found by a thorough osteopathic examination in order to unrestrict preformed cellular and humoral components back into the peripheral circulation.

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