D1.419 - The management of Immunological Diseases in Internal Medicine Departments

Immunological diseases, like autoimmune and autoinflammatory conditions, represent a clinical challenge within internal medicine departments. These disorders present with nonspecific or multisystemic symptoms, leading to delayed diagnosis and suboptimal management. Internal medicine plays a pivotal role in early identification and comprehensive care of patients with immunological diseases, given its multidisciplinary scope and systemic approach. This abstract highlights the need for better education, collaboration between immunology specialists and internists and integrated care pathways to better address the complexity of immunological diseases in internal medicine settings.

We administered a 12-question survey about the management of immunological diseases in internal medicine settings to 108 physicians registered with FADOI Campania (Scientific Society of Internal Medicine), 80% of whom were internal medicine ward physicians.

According to the survey, in approximately 90% of cases, serum protein electrophoresis is performed as routine test at first admission. When hypogammaglobulinemia is detected, 40% of physicians always proceed with further investigations, while 30% assess the severity of hypogammaglobulinemia before deciding whether to continue with additional tests. In presence of both hypogammaglobulinemia and reduced serum immunoglobulins, nearly 60% of physicians request an immunology consultation, 25% continue management within internal medicine, and 15% refer for a hematologic evaluation. About 40% of physicians are aware of existence of reference centers for immunodeficiencies in Campania and involve them in uncertain cases; however, only 47% of hospitals have a dedicated immunology outpatient service. The administration of immunoglobulin therapy is performed by 50% of physicians only following specialist recommendation. In cases of fever of unknown origin where no infectious cause is identified, 40% of physicians request immunology or rheumatology consultation, and 35% consider autoinflammatory diseases in differential diagnosis. In 98% of cases, the presence of recurrent sepsis, recurrent infections in any anatomical site, or cytopenias led physicians to pursue further diagnostic investigations in the presence of hypogammaglobulinemia. Among patients with history of oncohematologic diseases or immunosuppressive therapy, 54% of respondents reported routinely evaluating the serum protein profile, while 28% prioritized the resolution of sepsis and deferred comorbidity screening to specialized outpatient services. Only 19% considered a possible immunodeficiency in their immediate diagnostic approach. Regarding specific diagnostic tests, 66% of physicians reported ordering serum immunoglobulin levels and 26% requested immunoglobulin subclass testing.

The diagnostic approach to immunological diseases among internal medicine physicians represent a growing and cross-disciplinary challenge. Early recognition is critical to ensuring timely and effective management, reducing complications, and lowering healthcare costs. To achieve this, it is essential to strengthen the education of internists on immunological topics, implement shared diagnostic and therapeutic pathways. Only through an integrated, multidisciplinary and informed approach we can address the complexity of these conditions and significantly improve the quality of patient care.