In contrast, DIS patients exhibited more coordinated immune regulation, including sustained IL-13 production and higher IgA anti-S1 and IgA anti-RBD levels.<h4>Conclusions</h4>Integrated humoral and inflammatory signatures, particularly early IgM anti-N/anti-RBD responses and sequential increases in IFN-γ, TNF-α, FGF-basic, CXCL8, CCL4, CXCL10 and G-CSF, highlight immune signatures associated with poor outcomes. Here, CD40LG is linked to deafness-infertility syndrome.