Pub Date : 2024-09-07DOI: 10.1016/j.clicom.2024.09.001
Deficiency of Interleukin-1 receptor antagonist (DIRA) is a rare autosomal recessive autoinflammatory disease first reported in 2009. To date, 33 patients have been previously characterized and reported in literature. To the best of our knowledge, there have been no recent studies that have broadly evaluated recent advances in understanding of this challenging and life-threatening condition. Herein, we comprehensively reviewed the etiology and cytogenetic abnormalities of DIRA. We then investigated the current diagnostics used for identifying the variants of this disease. Furthermore, we report the demographics and characteristics broadly found in the current patient sample. Lastly, we discuss the treatments (antibiotics, corticosteroids, etc.) and the primary biologics (anakinra, canakinumab, adalimumab, and rilonacept) used in patients, along with current information on their clinical safety and efficacy. Overall, although further investigations are required for this disease, this review may be informative to clinicians treating and managing patients presenting with DIRA.
白细胞介素-1受体拮抗剂缺乏症(DIRA)是一种罕见的常染色体隐性自身炎症性疾病,于2009年首次报道。迄今为止,已有 33 例患者的特征被描述出来,并有文献报道。据我们所知,近期还没有任何研究广泛评估了对这种具有挑战性且危及生命的疾病的最新认识进展。在此,我们全面回顾了 DIRA 的病因和细胞遗传学异常。然后,我们研究了目前用于识别这种疾病变异体的诊断方法。此外,我们还报告了目前患者样本中广泛存在的人口统计学特征。最后,我们讨论了患者使用的治疗方法(抗生素、皮质类固醇等)和主要生物制剂(阿纳金拉、卡纳库单抗、阿达木单抗和利龙赛普),以及有关其临床安全性和有效性的最新信息。总之,尽管这种疾病还需要进一步的研究,但这篇综述可能会对治疗和管理DIRA患者的临床医生有所启发。
{"title":"Deficiency of interleukin-1 receptor antagonist: An updated review of the pathogenesis, clinical characteristics, and treatments","authors":"","doi":"10.1016/j.clicom.2024.09.001","DOIUrl":"10.1016/j.clicom.2024.09.001","url":null,"abstract":"<div><p>Deficiency of Interleukin-1 receptor antagonist (DIRA) is a rare autosomal recessive autoinflammatory disease first reported in 2009. To date, 33 patients have been previously characterized and reported in literature. To the best of our knowledge, there have been no recent studies that have broadly evaluated recent advances in understanding of this challenging and life-threatening condition. Herein, we comprehensively reviewed the etiology and cytogenetic abnormalities of DIRA. We then investigated the current diagnostics used for identifying the variants of this disease. Furthermore, we report the demographics and characteristics broadly found in the current patient sample. Lastly, we discuss the treatments (antibiotics, corticosteroids, etc.) and the primary biologics (anakinra, canakinumab, adalimumab, and rilonacept) used in patients, along with current information on their clinical safety and efficacy. Overall, although further investigations are required for this disease, this review may be informative to clinicians treating and managing patients presenting with DIRA.</p></div>","PeriodicalId":100269,"journal":{"name":"Clinical Immunology Communications","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772613424000131/pdfft?md5=efd31efbf265a26f98baec737ce483c3&pid=1-s2.0-S2772613424000131-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-23DOI: 10.1016/j.clicom.2024.06.001
Nancy E Aguilar Gómez , Uriel Pérez Blanco , Patricia Saltigeral Simental , Sara Espinosa Padilla , Jacinta Bustamante , Lizbeth Blancas Galicia
Chronic granulomatous disease (CGD) is an inborn error of immunity. NADPH oxidase is an enzyme complex that produces various reactive oxygen species, such as superoxide anions and hydrogen peroxide. Mycobacterial infections in CGD are commonly observed in countries with a high prevalence of these microorganisms, such as those receiving the BCG vaccination at birth or having a high prevalence of tuberculosis. Non-tuberculous mycobacteria (NTM) infections are rare in CGD. The patient also presented with hemophagocytic lymphohistiocytosis, which resolved with gammaglobulin and cyclosporine. Herein, we describe the first case of M. chimaera infection in a female patient with autosomal recessive CGD caused by a pathogenic variant in CYBA.
{"title":"First report of Mycobacterium chimaera infection in a patient with chronic granulomatous disease","authors":"Nancy E Aguilar Gómez , Uriel Pérez Blanco , Patricia Saltigeral Simental , Sara Espinosa Padilla , Jacinta Bustamante , Lizbeth Blancas Galicia","doi":"10.1016/j.clicom.2024.06.001","DOIUrl":"https://doi.org/10.1016/j.clicom.2024.06.001","url":null,"abstract":"<div><p>Chronic granulomatous disease (CGD) is an inborn error of immunity. NADPH oxidase is an enzyme complex that produces various reactive oxygen species, such as superoxide anions and hydrogen peroxide. Mycobacterial infections in CGD are commonly observed in countries with a high prevalence of these microorganisms, such as those receiving the BCG vaccination at birth or having a high prevalence of tuberculosis. Non-tuberculous mycobacteria (NTM) infections are rare in CGD. The patient also presented with hemophagocytic lymphohistiocytosis, which resolved with gammaglobulin and cyclosporine. Herein, we describe the first case of <em>M. chimaera</em> infection in a female patient with autosomal recessive CGD caused by a pathogenic variant in <em>CYBA</em>.</p></div>","PeriodicalId":100269,"journal":{"name":"Clinical Immunology Communications","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S277261342400012X/pdfft?md5=19c3dbec20ac96039288c28cf0222b45&pid=1-s2.0-S277261342400012X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141480453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-21DOI: 10.1016/j.clicom.2024.06.002
Aditya Sanjeevi , Brandon L Clark , Alfredo Aguirre , Basil George Verghese
We present an interesting case of a 65-year-old female patient who was taking fingolimod for relapsing-remitting multiple sclerosis. She presented with a tongue nodule, oral ulcer, and was found to have CD4 lymphocytopenia. HIV serology was negative. Fingolimod is known to cause lymphocyte redistribution to lymph nodes and was deemed to be the cause of CD4 lymphocytopenia in this patient. Further evaluation with excision biopsy of the tongue nodule confirmed histoplasmosis. Treatment with itraconazole resulted in a complete resolution of her lesions.
{"title":"Chronic disseminated histoplasmosis in a patient on fingolimod therapy: A case report and review of literature","authors":"Aditya Sanjeevi , Brandon L Clark , Alfredo Aguirre , Basil George Verghese","doi":"10.1016/j.clicom.2024.06.002","DOIUrl":"https://doi.org/10.1016/j.clicom.2024.06.002","url":null,"abstract":"<div><p>We present an interesting case of a 65-year-old female patient who was taking fingolimod for relapsing-remitting multiple sclerosis. She presented with a tongue nodule, oral ulcer, and was found to have CD4 lymphocytopenia. HIV serology was negative. Fingolimod is known to cause lymphocyte redistribution to lymph nodes and was deemed to be the cause of CD4 lymphocytopenia in this patient. Further evaluation with excision biopsy of the tongue nodule confirmed histoplasmosis. Treatment with itraconazole resulted in a complete resolution of her lesions.</p></div>","PeriodicalId":100269,"journal":{"name":"Clinical Immunology Communications","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772613424000118/pdfft?md5=4a91386357b81dc36b75c729025d4f97&pid=1-s2.0-S2772613424000118-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141482802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.clicom.2024.04.003
Marvyn T. Koning , Anouk Haine , Jesse Fens , Edske ter Bals , M. Cloos-van Balen , A. Faiz Karim
Multisystem Inflammatory Syndrome in Adults (MIS-A) is a rare complication after COVID-19 that mainly occurs in young adults. Patients typically present with unremitting fever, rash, conjunctivitis, neurological signs, shock, gastrointestinal symptoms and thrombocytopenia. Reported cases are scarce. Here we describe three new cases.
It is unclear to what extent MIS-A has a genetic basis, or whether MIS-A patients can be safely vaccinated after a case of MIS was reported after vaccination (termed MIS-V). We describe a monozygotic twin who was vaccinated without complications, suggesting no strict genetic basis for MIS-V. Furthermore, we report only the second case of MIS-A-related coronary aneurysm, which fully resolved upon regular treatment.
With the majority of young adults living in low resources settings, we suggest more focus on clinical parameters to support a MIS-A diagnosis. We report the first two patients of North-African descent. Currently, MIS-A may be an underappreciated complication of COVID-19 due to the lack of reports in non-Caucasian populations.
{"title":"Post COVID-19 multisystem inflammatory syndrome in adults (MIS-A): Underappreciated in international health? A Case Series","authors":"Marvyn T. Koning , Anouk Haine , Jesse Fens , Edske ter Bals , M. Cloos-van Balen , A. Faiz Karim","doi":"10.1016/j.clicom.2024.04.003","DOIUrl":"https://doi.org/10.1016/j.clicom.2024.04.003","url":null,"abstract":"<div><p>Multisystem Inflammatory Syndrome in Adults (MIS-A) is a rare complication after COVID-19 that mainly occurs in young adults. Patients typically present with unremitting fever, rash, conjunctivitis, neurological signs, shock, gastrointestinal symptoms and thrombocytopenia. Reported cases are scarce. Here we describe three new cases.</p><p>It is unclear to what extent MIS-A has a genetic basis, or whether MIS-A patients can be safely vaccinated after a case of MIS was reported after vaccination (termed MIS-V). We describe a monozygotic twin who was vaccinated without complications, suggesting no strict genetic basis for MIS-V. Furthermore, we report only the second case of MIS-A-related coronary aneurysm, which fully resolved upon regular treatment.</p><p>With the majority of young adults living in low resources settings, we suggest more focus on clinical parameters to support a MIS-A diagnosis. We report the first two patients of North-African descent. Currently, MIS-A may be an underappreciated complication of COVID-19 due to the lack of reports in non-Caucasian populations.</p></div>","PeriodicalId":100269,"journal":{"name":"Clinical Immunology Communications","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S277261342400009X/pdfft?md5=a1f4936a8315215cd8ec32b0eac35346&pid=1-s2.0-S277261342400009X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140823249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Immunological dysfunction in multiple lineages of hematopoietic cells and mixed chimerism after allogeneic hematopoietic stem cell transplantation (HSCT) are associated with an increased risk of autoimmunity in patients with Wiskott-Aldrich syndrome (WAS) and X-linked thrombocytopenia (XLT). Here, we report the efficacy of rituximab against autoimmunity in five patients with WAS and XLT. One patient with systemic arthritis and vasculitis, and two patients with immune thrombocytopenia were successfully treated with rituximab before initiating reduced-intensity conditioning. Rituximab was also used in combination with conditioning to prevent autoimmunity by depleting the recipient B cells in the other two patients with XLT. None of the patients developed autoimmunity without delay in donor B cell reconstitution, even though two patients had stable mixed chimerism after HSCT. These results suggest that aberrant B cell-intrinsic mechanisms are a central cause of autoimmunity, and rituximab is an effective therapeutic option for autoimmunity in patients with WAS and XLT.
维斯科特-阿尔德里奇综合征(WAS)和X连锁血小板减少症(XLT)患者异基因造血干细胞移植(HSCT)后多系造血细胞免疫功能障碍和混合嵌合体与自身免疫风险增加有关。在此,我们报告了利妥昔单抗对五名 WAS 和 XLT 患者自身免疫的疗效。一名患者患有全身性关节炎和血管炎,两名患者患有免疫性血小板减少症,他们在开始减敏治疗前成功接受了利妥昔单抗治疗。利妥昔单抗还与调理联合使用,通过消耗另外两名XLT患者的受体B细胞来预防自身免疫。尽管有两名患者在造血干细胞移植后出现了稳定的混合嵌合体,但在供体B细胞重建没有延迟的情况下,没有一名患者出现自身免疫。这些结果表明,B细胞内在机制异常是自身免疫的核心原因,而利妥昔单抗是治疗WAS和XLT患者自身免疫的有效方法。
{"title":"Efficacy of rituximab for the treatment and prevention of autoimmunity in patients with Wiskott-Aldrich syndrome and X-linked thrombocytopenia","authors":"Saori Katayama, Tomohiro Nakano, Tasuku Suzuki, Masahiro Irie, Hidetaka Niizuma, Atsuo Kikuchi, Yoji Sasahara","doi":"10.1016/j.clicom.2024.04.002","DOIUrl":"https://doi.org/10.1016/j.clicom.2024.04.002","url":null,"abstract":"<div><p>Immunological dysfunction in multiple lineages of hematopoietic cells and mixed chimerism after allogeneic hematopoietic stem cell transplantation (HSCT) are associated with an increased risk of autoimmunity in patients with Wiskott-Aldrich syndrome (WAS) and X-linked thrombocytopenia (XLT). Here, we report the efficacy of rituximab against autoimmunity in five patients with WAS and XLT. One patient with systemic arthritis and vasculitis, and two patients with immune thrombocytopenia were successfully treated with rituximab before initiating reduced-intensity conditioning. Rituximab was also used in combination with conditioning to prevent autoimmunity by depleting the recipient B cells in the other two patients with XLT. None of the patients developed autoimmunity without delay in donor B cell reconstitution, even though two patients had stable mixed chimerism after HSCT. These results suggest that aberrant B cell-intrinsic mechanisms are a central cause of autoimmunity, and rituximab is an effective therapeutic option for autoimmunity in patients with WAS and XLT.</p></div>","PeriodicalId":100269,"journal":{"name":"Clinical Immunology Communications","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772613424000088/pdfft?md5=0e10a31d2d2652dc8d7440e727722666&pid=1-s2.0-S2772613424000088-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140644850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1016/j.clicom.2024.04.001
Mariam A Mostafa , Sheref Elseidy , Reham Ali Metwally , Amir Mahmoud , Ali Abdelhay , Farhan S. Imran
Acquired hemophilia A is a rare but serious bleeding disorder that occurs because of neutralizing autoantibodies, also called inhibitors that target coagulation factor VIII (FVIII). Although it is a rare disorder, it has high morbidity and mortality with serious, sometimes life-threatening bleeding, often occurring. Immunotherapy with immune checkpoint inhibitors (ICI) is now a key pillar in treatment of malignancies. They have improved outcomes in malignancy but given their mechanism of action, which stimulates the immune response, autoimmune-associated adverse effects are a concern. Several case reports have identified a risk of AHA occurrence in patients treated with ICI. There are no case reports documenting the use or outcomes of ICI in patients with pre-existing AHA. Here we present the first ever case of a patient with AHA in complete remission treated successfully with ICI for lung cancer without relapse in AHA.
获得性血友病 A 是一种罕见但严重的出血性疾病,是由于针对凝血因子 VIII(FVIII)的中和自身抗体(也称为抑制剂)引起的。虽然这是一种罕见的疾病,但它的发病率和死亡率很高,经常会发生严重出血,有时甚至危及生命。免疫检查点抑制剂(ICI)免疫疗法目前已成为治疗恶性肿瘤的关键支柱。它们改善了恶性肿瘤的治疗效果,但由于其作用机制是刺激免疫反应,因此与自身免疫相关的不良反应令人担忧。一些病例报告发现,接受 ICI 治疗的患者有发生 AHA 的风险。目前还没有病例报告记录 ICI 在已有 AHA 的患者中的使用情况或结果。在此,我们介绍了有史以来第一例完全缓解的 AHA 患者在接受 ICI 治疗肺癌后未复发 AHA 的成功病例。
{"title":"First reported use of immune checkpoint inhibitor for treatment of cancer in a patient with acquired hemophilia A","authors":"Mariam A Mostafa , Sheref Elseidy , Reham Ali Metwally , Amir Mahmoud , Ali Abdelhay , Farhan S. Imran","doi":"10.1016/j.clicom.2024.04.001","DOIUrl":"10.1016/j.clicom.2024.04.001","url":null,"abstract":"<div><p>Acquired hemophilia A is a rare but serious bleeding disorder that occurs because of neutralizing autoantibodies, also called inhibitors that target coagulation factor VIII (FVIII). Although it is a rare disorder, it has high morbidity and mortality with serious, sometimes life-threatening bleeding, often occurring. Immunotherapy with immune checkpoint inhibitors (ICI) is now a key pillar in treatment of malignancies. They have improved outcomes in malignancy but given their mechanism of action, which stimulates the immune response, autoimmune-associated adverse effects are a concern. Several case reports have identified a risk of AHA occurrence in patients treated with ICI. There are no case reports documenting the use or outcomes of ICI in patients with pre-existing AHA. Here we present the first ever case of a patient with AHA in complete remission treated successfully with ICI for lung cancer without relapse in AHA.</p></div>","PeriodicalId":100269,"journal":{"name":"Clinical Immunology Communications","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772613424000076/pdfft?md5=7a969c587bdd6b21a30b1d5cc76f5f5e&pid=1-s2.0-S2772613424000076-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140762660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-06DOI: 10.1016/j.clicom.2024.03.001
Elise M.N. Ferré , Chyi-Chia R. Lee , Michail S. Lionakis
Autoimmune-Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy (APECED) is a monogenic autoimmune disease most often resulting from biallelic loss-of-function variants in the autoimmune regulator (AIRE) gene. Although typically characterized by the classic triad of chronic mucocutaneous candidiasis, hypoparathyroidism, and adrenal insufficiency, we have recently reported that the clinical spectrum of the syndrome is far broader that previously described and that incorporation of an adjunct triad of APECED rash, autoimmune enteritis-associated intestinal dysfunction, and enamel hypoplasia in the classic triad manifestations could lead to earlier diagnosis. Among the adjunct triad manifestations, APECED rash occurs in 66 % of American APECED patients by age 3, most often developing in the first year of life. Here, we describe the clinical and histological features of protracted APECED rash manifesting together with recurrent mucocutaneous candidiasis as the first two disease components of APECED in a 10-month-old girl.
{"title":"Early recognition of the APECED rash can accelerate the diagnosis of APECED","authors":"Elise M.N. Ferré , Chyi-Chia R. Lee , Michail S. Lionakis","doi":"10.1016/j.clicom.2024.03.001","DOIUrl":"https://doi.org/10.1016/j.clicom.2024.03.001","url":null,"abstract":"<div><p>Autoimmune-Polyendocrinopathy-Candidiasis-Ectodermal Dystrophy (APECED) is a monogenic autoimmune disease most often resulting from biallelic loss-of-function variants in the autoimmune regulator (<em>AIRE</em>) gene. Although typically characterized by the classic triad of chronic mucocutaneous candidiasis, hypoparathyroidism, and adrenal insufficiency, we have recently reported that the clinical spectrum of the syndrome is far broader that previously described and that incorporation of an adjunct triad of APECED rash, autoimmune enteritis-associated intestinal dysfunction, and enamel hypoplasia in the classic triad manifestations could lead to earlier diagnosis. Among the adjunct triad manifestations, APECED rash occurs in 66 % of American APECED patients by age 3, most often developing in the first year of life. Here, we describe the clinical and histological features of protracted APECED rash manifesting together with recurrent mucocutaneous candidiasis as the first two disease components of APECED in a 10-month-old girl.</p></div>","PeriodicalId":100269,"journal":{"name":"Clinical Immunology Communications","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772613424000064/pdfft?md5=0a30287078275916ae14bcd735f32528&pid=1-s2.0-S2772613424000064-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140069119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Syndrome of Congenital Sideroblastic Anemia, B-cell Immunodeficiency, Periodic Fevers, and Developmental Delay (SIFD) is caused by mutations in the tRNA nucleotidyltransferase 1 (TRNT1) gene. We present the case of a 13-month-old boy with developmental delay, microcytic anemia, and recurrent febrile illnesses. Immunological workup revealed B cell lymphopenia. Whole exome sequencing identified two novel heterozygous mutations in the TRNT1 gene (Thr49Fs and Ile122Thr). Our patient had a milder phenotype than previously reported cases of sideroblastic anemia. However, he developed left ventricular dilated cardiomyopathy at the age of 2 years. At the age of 5 years, COVID-19 infection resulted in mitochondrial encephalomyopathy and respiratory failure. Subsequent immunology evaluation revealed low IgG levels, prompting the initiation of immunoglobulin replacement therapy. This case highlights the importance of genetic testing in multisystem disorders and the variable clinical course in SIFD patients. Additionally, it emphasizes the unique susceptibility to COVID-19 due to immunodeficiency and mitochondrial defects.
{"title":"Case of Mitochondrial Encephalomyopathy secondary to COVID-19 in a Pediatric case of SIFD syndrome with a novel TRNT1 mutation","authors":"Amer Khojah , Lauren Gunderman , Ameera Bukhari , Aisha Mirza , Madeline Schutt , Aisha Ahmed","doi":"10.1016/j.clicom.2024.02.003","DOIUrl":"https://doi.org/10.1016/j.clicom.2024.02.003","url":null,"abstract":"<div><p>Syndrome of Congenital Sideroblastic Anemia, B-cell Immunodeficiency, Periodic Fevers, and Developmental Delay (SIFD) is caused by mutations in the tRNA nucleotidyltransferase 1 (TRNT1) gene. We present the case of a 13-month-old boy with developmental delay, microcytic anemia, and recurrent febrile illnesses. Immunological workup revealed B cell lymphopenia. Whole exome sequencing identified two novel heterozygous mutations in the TRNT1 gene (Thr49Fs and Ile122Thr). Our patient had a milder phenotype than previously reported cases of sideroblastic anemia. However, he developed left ventricular dilated cardiomyopathy at the age of 2 years. At the age of 5 years, COVID-19 infection resulted in mitochondrial encephalomyopathy and respiratory failure. Subsequent immunology evaluation revealed low IgG levels, prompting the initiation of immunoglobulin replacement therapy. This case highlights the importance of genetic testing in multisystem disorders and the variable clinical course in SIFD patients. Additionally, it emphasizes the unique susceptibility to COVID-19 due to immunodeficiency and mitochondrial defects.</p></div>","PeriodicalId":100269,"journal":{"name":"Clinical Immunology Communications","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772613424000040/pdfft?md5=b95db347be3534412ee33edfd539b671&pid=1-s2.0-S2772613424000040-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139993379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1016/j.clicom.2024.02.002
Amer Khojah , Madeline Schutt , Gabrielle Morgan , Ameera Bukhari , Nicolas Bensen , Aaruni Khanolkar , Lauren M. Pachman
This study investigates HLA-DR expression on activated T cells and serum neopterin levels in Juvenile Dermatomyositis (JDM) children pre- and post-treatment. Sixty-nine JDM children (less than 18 years) were included. Elevated HLA-DR+ T cells (>7 %) were observed in 19 % of untreated cases. Post-treatment, mean HLA-DR+ T cells decreased from 5.1 to 2.9 (P < 0.001), and serum neopterin levels declined from 19.3 to 9.1 nmol/L (P < 0.0001). A positive correlation between serum neopterin and HLA-DR T cell percentage was observed (r = 0.39, P = 0.01). Intravenous steroid treatment exhibited a 47.4 % improvement in HLA-DR+ T cells and a 50.5 % reduction in serum neopterin levels, in contrast to 14.8 % and 34.1 % in the oral steroid group. In conclusion, treatment, particularly with IV steroids, significantly improved HLA-DR+ T cells percentage and neopterin levels. A correlation between HLA-DR+ T cells percentage and serum neopterin was noted in untreated JDM patients.
本研究调查了幼年皮肌炎(JDM)儿童治疗前后活化 T 细胞上的 HLA-DR 表达和血清蝶呤水平。研究共纳入 69 名 JDM 儿童(18 岁以下)。在19%的未治疗病例中观察到HLA-DR+ T细胞升高(7%)。治疗后,HLA-DR+ T 细胞平均值从 5.1 降至 2.9(P <0.001),血清新蝶呤水平从 19.3 降至 9.1 nmol/L(P <0.0001)。血清蝶呤与 HLA-DR T 细胞百分比呈正相关(r = 0.39,P = 0.01)。静脉注射类固醇治疗后,HLA-DR+ T 细胞的比例提高了 47.4%,血清蝶呤水平降低了 50.5%,而口服类固醇组的比例分别为 14.8% 和 34.1%。总之,治疗(尤其是静脉注射类固醇)能明显改善 HLA-DR+ T 细胞的比例和新蝶呤水平。在未经治疗的 JDM 患者中,HLA-DR+ T 细胞百分比与血清蝶呤之间存在相关性。
{"title":"Increased percentage of HLA-DR T cells in untreated juvenile dermatomyositis","authors":"Amer Khojah , Madeline Schutt , Gabrielle Morgan , Ameera Bukhari , Nicolas Bensen , Aaruni Khanolkar , Lauren M. Pachman","doi":"10.1016/j.clicom.2024.02.002","DOIUrl":"https://doi.org/10.1016/j.clicom.2024.02.002","url":null,"abstract":"<div><p>This study investigates HLA-DR expression on activated T cells and serum neopterin levels in Juvenile Dermatomyositis (JDM) children pre- and post-treatment. Sixty-nine JDM children (less than 18 years) were included. Elevated HLA-DR+ <em>T</em> cells (>7 %) were observed in 19 % of untreated cases. Post-treatment, mean HLA-DR+ <em>T</em> cells decreased from 5.1 to 2.9 (<em>P</em> < 0.001), and serum neopterin levels declined from 19.3 to 9.1 nmol/L (<em>P</em> < 0.0001). A positive correlation between serum neopterin and HLA-DR T cell percentage was observed (<em>r</em> = 0.39, <em>P</em> = 0.01). Intravenous steroid treatment exhibited a 47.4 % improvement in HLA-DR+ <em>T</em> cells and a 50.5 % reduction in serum neopterin levels, in contrast to 14.8 % and 34.1 % in the oral steroid group. In conclusion, treatment, particularly with IV steroids, significantly improved HLA-DR+ <em>T</em> cells percentage and neopterin levels. A correlation between HLA-DR+ <em>T</em> cells percentage and serum neopterin was noted in untreated JDM patients.</p></div>","PeriodicalId":100269,"journal":{"name":"Clinical Immunology Communications","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772613424000052/pdfft?md5=c452f7a7248afcb618c034100a4de811&pid=1-s2.0-S2772613424000052-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139993378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Good syndrome (GS) is a combined immunodeficiency that is associated with thymomas. The cause of the reduction in B-cells in patients with GS may be multifactorial and may include dysregulated T-cell responses. It has been proposed that tumorigenesis in a normal thymus alters thymic epithelial cell function, which leads to attenuated elimination of T-cells autoreactive to B-cells. Although the comprehensive genetic analysis of thymoma has been performed and reported in many articles, the comprehensive genetic analysis specified for GS-related thymoma has not been reported. Herein, we report comprehensive genetic analysis of a thymoma taken from a patient with GS. Oncogenesis-associated genes that may contribute to thymoma development were detected. Additionally, alteration of VCAM1, which is required in the interaction between T-cells and thymic epithelial cells, was observed. Aberrantly expressed VCAM1 in thymic epithelial cells may decrease the efficacy of negative of selection autoreactive T-cells and contribute to autoimmunity to B-cells.
古德综合征(GS)是一种与胸腺瘤相关的联合免疫缺陷病。古德综合征患者 B 细胞减少的原因可能是多因素的,其中可能包括 T 细胞反应失调。有人认为,正常胸腺中的肿瘤发生改变了胸腺上皮细胞的功能,从而导致对 B 细胞有自反应的 T 细胞的清除能力减弱。虽然已有许多文章对胸腺瘤进行了全面的基因分析和报道,但专门针对 GS 相关胸腺瘤的全面基因分析尚未见报道。在此,我们报告了对一名 GS 患者胸腺瘤的全面基因分析。我们发现了可能导致胸腺瘤发生的肿瘤发生相关基因。此外,我们还观察到T细胞与胸腺上皮细胞之间相互作用所需的VCAM1发生了改变。胸腺上皮细胞中畸形表达的VCAM1可能会降低自体反应性T细胞负向选择的功效,并导致B细胞自身免疫。
{"title":"Somatic variant profiling of a thymoma in Good syndrome","authors":"Kae Takagi , Yui Namikawa , Masayuki Nagasawa , Masahiro Mae , Yoshihiko Watanabe , Kohsuke Imai , Hirokazu Kanegane , Tomohiro Morio , Masatoshi Takagi","doi":"10.1016/j.clicom.2024.02.004","DOIUrl":"https://doi.org/10.1016/j.clicom.2024.02.004","url":null,"abstract":"<div><p>Good syndrome (GS) is a combined immunodeficiency that is associated with thymomas. The cause of the reduction in B-cells in patients with GS may be multifactorial and may include dysregulated T-cell responses. It has been proposed that tumorigenesis in a normal thymus alters thymic epithelial cell function, which leads to attenuated elimination of T-cells autoreactive to B-cells. Although the comprehensive genetic analysis of thymoma has been performed and reported in many articles, the comprehensive genetic analysis specified for GS-related thymoma has not been reported. Herein, we report comprehensive genetic analysis of a thymoma taken from a patient with GS. Oncogenesis-associated genes that may contribute to thymoma development were detected. Additionally, alteration of <em>VCAM1</em>, which is required in the interaction between T-cells and thymic epithelial cells, was observed. Aberrantly expressed VCAM1 in thymic epithelial cells may decrease the efficacy of negative of selection autoreactive T-cells and contribute to autoimmunity to B-cells.</p></div>","PeriodicalId":100269,"journal":{"name":"Clinical Immunology Communications","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772613424000039/pdfft?md5=cb5d7cc0913d4adf0ba1ae4f12b0b913&pid=1-s2.0-S2772613424000039-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139936671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}