Omenn Syndrome Differential Diagnoses

Updated: Apr 28, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Harumi Jyonouchi, MD  more...
  • Print

Diagnostic Considerations

The major reason for a missed or delayed diagnosis of Omenn syndrome is the eczematoid appearance of the dermatitis when the infections have not yet appeared. The eczema associated with diarrhea raises the possibility of a food allergy. Nevertheless, Omenn syndrome is usually accompanied by a failure to thrive not expected with common atopic dermatitis and by hypereosinophilia. Furthermore, the dermatitis has the unique appearance of pachydermia, which progresses to desquamation.

The clinical presentation also may suggest the possibility of other forms of severe combined immunodeficiency (SCID) complicated by maternal T-cell engraftment or transfusion-related graft versus host disease (GVHD). Patients with these conditions are typically more lymphopenic than those with other diseases.

Hyperimmunoglobulin E (HIE) syndrome in infants may need to be considered because these infants have eczema and infections with Candida species and S aureus. However, patients with Omenn syndrome are likely to have invasive infections, such as staphylococcal sepsis, whereas patients with HIE syndrome have infections limited to the lung, skin, and mucosal surfaces.

Noninfectious cutaneous granulomas may rarely be evident in patients with the Omenn syndrome. [17, 18]

Differential Diagnoses