SECONDARY IMMUNODEFICIENCY DUE TO GAMING DISORDER

Introduction Gaming disorder is a new ICD-11 diagnosis wherein obsessive video-gaming results in an interference of daily activities, which can lead to downstream health effects such as cachexia and malnutrition. We report a patient whose gaming disorder led to severe malnutrition and secondary immunodeficiency. Case Description A 29-year-old male presents with 4 months of bilateral leg swelling, chronic cough, lethargy, decreased appetite, and unintentional weight loss. Physical exam was significant for bradycardia, decreased breath sounds, and lower extremity pitting edema with ulcerations. Radiologic evaluation demonstrated bilateral upper lung lobe cavitary lesions with bronchiectasis and anasarca. Sputum was positive for acid fast bacilli, and cultures grew Mycobacterium abscessus. HIV screen was negative. Labs showed severe monocytopenia, reduced circulating NK cells, and low B and T cells. Monocytopenia and mycobacterial infection (MonoMac) syndrome was suspected due to patient's nontuberculous mycobacterial infection, lymphedema, monocytopenia and lymphopenia. Whole exome analysis of a panel of immune related genes associated with mendellian susceptibility to mycobacteria was negative, including GATA2. Bone marrow biopsy revealed gelatinous transformation of the bone marrow seen in malnutrition. Patient's negative primary immunodeficiency workup suggested that his immunodeficiency was secondary to malnutrition. Further history from family revealed that the patient spent most of the day playing video games and not eating, suggestive of gaming disorder. With improved nutritional status, patient's monocytopenia and lymphocytopenia resolved. Discussion This is the first case report to our knowledge in which gaming disorder resulted in secondary immunodeficiency.