Immunophenotypic changes in pediatric patients with recurrent infections following inosine acedoben dimepranol therapy: a case-based analysis

Background : Recurrent infections in children may occur despite normal baseline immune function, highlighting the need for targeted immunomodulatory interventions. Prior use of other immunomodulators, such as bacterial lysates and beta-glucans, can influence immune parameters and should be considered when interpreting treatment effects. Objective : To evaluate the short-term effects of inosine acedoben dimepranol (IAD) on immune cell subsets and activation markers in two pediatric patients with recurrent infections. Methods : Two children aged 3 years with frequent infections but normal routine immunological screening were treated with IAD for a brief 7-day period as part of a broader adjunctive immunotherapy regimen, including other immunomodulators. Comprehensive immunophenotyping of T, B, and natural killer (NK) cells, as well as subset-specific naïve, memory, and activation markers (CD38, CD25, and HLA-DR), was performed before and after therapy using flow cytometry. Results : Baseline analysis revealed distinct immune dysregulation patterns: B-cell predominance in one patient and T-cell, mainly CD4+, expansion in the other, accompanied by evidence of chronic immune activation. Following short-term IAD administration, both patients demonstrated case-specific, transient immunological changes, including partial normalization of naïve CD4+ T-cell proportions, reduction of some activation markers, and modest changes in memory B-cell subsets. Absolute lymphocyte counts and subset dynamics were consistent with short-term clinical observations. No adverse effects were observed during treatment. Conclusion : Short-term IAD therapy was associated with preliminary, case-specific modulation of lymphocyte compartments and partial attenuation of chronic immune activation. Given the brief duration and concurrent use of other immunomodulators, these findings should be interpreted cautiously. Nevertheless, detailed immunophenotyping can provide valuable insights to guide individualized adjunctive immunomodulatory therapy in pediatric patients.