Sponge-like sonographic pattern of the spleen in immune dysregulation disorders

By
Giorgio Costagliola
Emanuela De Marco
Leonardo Amato
Giulia Roberti
Elena Sabattini
Fabrizio Catena
Mattia Moratti
Gabriella Casazza
Francesca Conti
Rita Consolini
June 15, 2026
0 min

Frontiers In Immunology

Overview

This report describes a novel 'sponge-like' splenic microtexture pattern observed in patients with inborn errors of immunity (IEI) and hematologic immune dysregulation.

Background

Inborn errors of immunity (IEIs) encompass a variety of disorders that can lead to significant immune dysregulation, including autoimmune cytopenia and lymphoproliferation. Routine ultrasound assessments of the spleen are common in these patients, yet the microtexture of the spleen has not been thoroughly investigated.

Data Highlights

Parameter	IEI Cohort	Control Group
Splenomegaly	46.2%	5%
Sponge-like pattern	30.8%	5%

Key Findings

A 'sponge-like' splenic microtexture was identified in an 11-year-old patient with autoimmune lymphoproliferative immunodeficiency.
In a cohort of 26 patients with IEIs, 30.8% exhibited a persistent sponge-like pattern on ultrasound.
Only one patient in a control group of 20 showed similar features, which were transient during acute EBV infection.
Immunomodulatory treatments led to significant improvement or normalization of the sponge-like pattern in all cases.

Clinical Implications

The identification of a sponge-like splenic microtexture in patients with signs of immune dysregulation may aid in the early suspicion of underlying inborn errors of immunity.

Conclusion

The association between the sponge-like splenic microtexture and immune dysregulation in patients with IEIs highlights the need for further investigation.