51
|
Cheng C, Chen L, Wen S, Lin Z, Jiang X. Case Report: Denys-Drash Syndrome With WT1 Causative Variant Presenting as Atypical Hemolytic Uremic Syndrome. Front Pediatr 2020; 8:605889. [PMID: 33392118 PMCID: PMC7775732 DOI: 10.3389/fped.2020.605889] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/03/2020] [Indexed: 01/04/2023] Open
Abstract
The WT1 variant is confirmed to be pathogenic for Denys-Drash syndrome (DDS), a rare disorder characterized by early-onset nephrotic syndrome and renal failure, pseudo-hermaphroditism, and a high risk of Wilms' tumor. Several cases of DDS presenting with atypical hemolytic uremic syndrome (aHUS) have been reported. Here we report the case of a 2-year-old child who was diagnosed with WT1 missense variant, associated with DDS and initial presentation of aHUS. Complement factor H autoantibodies were negative. Complement regulatory system-related gene variants were not found, but a de novo heterozygous c.754G>A missense variant in exon 9 of WT1 gene was detected, resulting in a p. Asp252Asn substitution, by next-generation sequencing. The patient was a female morphologically but proved to be a genetic male because of karyotype 46, XY with normally developed female external genitalia. Bilateral nephrectomy and renal transplantation were performed 1 year later, and there was no recurrence of aHUS at 10 months after transplantation.
Collapse
Affiliation(s)
- Cheng Cheng
- Department of Pediatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lizhi Chen
- Department of Pediatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sijia Wen
- Department of Pediatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhilang Lin
- Department of Pediatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoyun Jiang
- Department of Pediatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
52
|
Abstract
Evaluating, diagnosing, and managing patients with consumptive thrombocytopenia is challenging because of the overlapping nature of many of the diseases that reduce platelet counts. Immune thrombocytopenia (and its variations), drug-induced immune thrombocytopenia, and heparin-induced thrombocytopenia result from autoimmune antibody-mediated destruction of platelets. Thrombotic thrombocytopenia (both congenital and acquired) and the hemolytic uremic syndromes (both typical and atypical) are thrombotic microangiopathies associated with platelet aggregation and consumption along with anemia and renal dysfunction. Rapid history taking, physical assessment, and laboratory evaluation are crucial to accurately managing patients with these disorders. Platelet-associated coagulopathies are infrequently encountered by most providers, and limited exposure to these types of patients, combined with the wide variety of treatment options for reversing bleeding or thrombotic sequelae, makes management difficult. This article reviews the pathophysiology, patient presentation, diagnostic testing, and specific management strategies and challenges of these thrombocytopenias.
Collapse
Affiliation(s)
- Thomas A VanDruff
- Thomas A. VanDruff is Critical Care Nurse Practitioner, PMA Health at the Virginia Hospital Center, 1625 North George Mason Drive, Arlington, VA 22205
| |
Collapse
|
53
|
van den Broek B, van Els CACM, Kuipers B, van Aerde K, Henriet SS, de Groot R, de Jonge MI, Langereis JD, van der Flier M. Multi-component meningococcal serogroup B (MenB)-4C vaccine induces effective opsonophagocytic killing in children with a complement deficiency. Clin Exp Immunol 2019; 198:381-389. [PMID: 31487400 PMCID: PMC6857189 DOI: 10.1111/cei.13368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2019] [Indexed: 01/09/2023] Open
Abstract
Vaccination against meningococcal serogroup B is recommended for patients with a complement deficiency; however, although immunogenicity in this patient group has been shown, efficacy has not yet been established. In this study, we collected serum from children with a complement deficiency in the alternative pathway or in late terminal pathway before and after vaccination with multi-component meningococcal serogroup B (MenB)-4C. MenB-4C is a multi-component, protein-based vaccine against MenB consisting of factor H-binding protein, Neisserial heparin-binding protein, Neisserial adhesion A and outer membrane vesicles containing Porin A. We assessed the vaccine immunogenicity and vaccine-mediated protection by a whole cell enzyme-linked immunosorbent assay with Neisseria meningitidis serogroup B strains H44/76, 5/99 and NZ98/254, which shows that vaccination induced antibody titers against meningococcus. We show that the classical serum bactericidal activity assay with exogenous serum indicates the presence of vaccine-induced antibodies and capacity to activate complement-mediated pathogen lysis. However, in children with a late terminal pathway deficiency, no complement-mediated pathogen lysis was observed when autologous serum was applied in the serum bactericidal activity assay, demonstrating a lack of serum bactericidal activity in children with complement deficiencies. However, MenB-4C vaccination still induced effective complement-dependent opsonophagocytic killing against N. meningitidis serogroup B in reconstituted whole blood with autologous serum from children with an alternative pathway or late terminal pathway deficiency. These findings support the recommendation to vaccinate all complement-deficient children against MenB.
Collapse
Affiliation(s)
- B. van den Broek
- Pediatric Infectious Diseases and ImmunologyAmalia Children’s HospitalNijmegenthe Netherlands
- Expertise Center for Immunodeficiency and Autoinflammation (REIA)Radboudumc, Nijmegenthe Netherlands
- Section Pediatric Infectious DiseasesLaboratory of Medical ImmunologyRadboud Institute for Molecular Life SciencesRadboudumc, Nijmegenthe Netherlands
- Radboud Center for Infectious DiseasesRadboudumc, Nijmegenthe Netherlands
| | - C. A. C. M. van Els
- Centre for Infectious Disease ControlNational Institute for Public Health and the Environment (RIVM)Bilthoventhe Netherlands
| | - B. Kuipers
- Centre for Infectious Disease ControlNational Institute for Public Health and the Environment (RIVM)Bilthoventhe Netherlands
| | - K. van Aerde
- Pediatric Infectious Diseases and ImmunologyAmalia Children’s HospitalNijmegenthe Netherlands
- Expertise Center for Immunodeficiency and Autoinflammation (REIA)Radboudumc, Nijmegenthe Netherlands
- Section Pediatric Infectious DiseasesLaboratory of Medical ImmunologyRadboud Institute for Molecular Life SciencesRadboudumc, Nijmegenthe Netherlands
- Radboud Center for Infectious DiseasesRadboudumc, Nijmegenthe Netherlands
| | - S. S. Henriet
- Pediatric Infectious Diseases and ImmunologyAmalia Children’s HospitalNijmegenthe Netherlands
- Expertise Center for Immunodeficiency and Autoinflammation (REIA)Radboudumc, Nijmegenthe Netherlands
- Section Pediatric Infectious DiseasesLaboratory of Medical ImmunologyRadboud Institute for Molecular Life SciencesRadboudumc, Nijmegenthe Netherlands
- Radboud Center for Infectious DiseasesRadboudumc, Nijmegenthe Netherlands
| | - R. de Groot
- Section Pediatric Infectious DiseasesLaboratory of Medical ImmunologyRadboud Institute for Molecular Life SciencesRadboudumc, Nijmegenthe Netherlands
- Radboud Center for Infectious DiseasesRadboudumc, Nijmegenthe Netherlands
| | - M. I. de Jonge
- Section Pediatric Infectious DiseasesLaboratory of Medical ImmunologyRadboud Institute for Molecular Life SciencesRadboudumc, Nijmegenthe Netherlands
- Radboud Center for Infectious DiseasesRadboudumc, Nijmegenthe Netherlands
| | - J. D. Langereis
- Section Pediatric Infectious DiseasesLaboratory of Medical ImmunologyRadboud Institute for Molecular Life SciencesRadboudumc, Nijmegenthe Netherlands
- Radboud Center for Infectious DiseasesRadboudumc, Nijmegenthe Netherlands
| | - M. van der Flier
- Pediatric Infectious Diseases and ImmunologyAmalia Children’s HospitalNijmegenthe Netherlands
- Expertise Center for Immunodeficiency and Autoinflammation (REIA)Radboudumc, Nijmegenthe Netherlands
- Section Pediatric Infectious DiseasesLaboratory of Medical ImmunologyRadboud Institute for Molecular Life SciencesRadboudumc, Nijmegenthe Netherlands
- Radboud Center for Infectious DiseasesRadboudumc, Nijmegenthe Netherlands
- Present address:
Pediatric Infectious Diseases and ImmunologyWilhelmina Children's Hospital, University Medical Center UtrechtUtrechtthe Netherlands
| |
Collapse
|
54
|
Extrarenal Immune-Mediated Disorders Linked with Acute Poststreptococcal Glomerulonephritis: a Systematic Review. Clin Rev Allergy Immunol 2019; 57:294-302. [DOI: 10.1007/s12016-019-08761-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
55
|
van den Broek B, van der Flier M, de Groot R, de Jonge MI, Langereis JD. Common Genetic Variants in the Complement System and their Potential Link with Disease Susceptibility and Outcome of Invasive Bacterial Infection. J Innate Immun 2019; 12:131-141. [PMID: 31269507 DOI: 10.1159/000500545] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/19/2019] [Indexed: 01/01/2023] Open
Abstract
Streptococcus pneumoniae and Neisseria meningitidis are pathogens that frequently colonize the nasopharynx in an asymptomatic manner but are also a cause of invasive bacterial infections mainly in young children. The complement system plays a crucial role in humoral immunity, complementing the ability of antibodies to clear microbes, thereby protecting the host against bacterial infections, including S. pneumoniae and N. meningitidis. While it is widely accepted that complement deficiencies due to rare genetic variants increase the risk for invasive bacterial infection, not much is known about the common genetic variants in the complement system in relation to disease susceptibility. In this review, we provide an overview of the effects of common genetic variants on complement activation and on complement-mediated inflammation.
Collapse
Affiliation(s)
- Bryan van den Broek
- Paediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Nijmegen, The Netherlands.,Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands
| | - Michiel van der Flier
- Paediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Nijmegen, The Netherlands.,Expertise Center for Immunodeficiency and Auto inflammation (REIA), Radboudumc, Nijmegen, The Netherlands.,Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands
| | - Ronald de Groot
- Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands
| | - Marien I de Jonge
- Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands.,Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands
| | - Jeroen D Langereis
- Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands, .,Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands,
| |
Collapse
|
56
|
Al-Shyoukh A, Younis M, Abughanimeh O, Tahboub M, Hamarshi MS. An Unusual Case of Diffuse Alveolar Hemorrhage as a Clinical Manifestation of Atypical Hemolytic Uremic Syndrome: A Case Report. Cureus 2019; 11:e5059. [PMID: 31516771 PMCID: PMC6721894 DOI: 10.7759/cureus.5059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hemolytic uremic syndrome (HUS) is a constellation of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal injury. HUS is subcategorized into primary or secondary HUS. Primary HUS is synonymous with atypical HUS (aHUS) and is attributed to genetic complement deficiency. Diffuse alveolar hemorrhage (DAH) is a serious condition complicating multiple systemic conditions. aHUS presenting as DAH is exceedingly rare. In this case, we present a 75-year-old male patient who presented with generalized weakness, malaise, and hemoptysis. He was found to have hemolytic anemia and thrombocytopenia, with elevated creatinine. Bronchoscopy confirmed DAH. He was started on plasmapheresis with a suboptimal response. aHUS was suspected and the patient was started on eculizumab with subsequent laboratory and clinical improvement. HUS and aHUS can present as DAH. It is very important to recognize both conditions as both are life threatening with high morbidity and mortality.
Collapse
Affiliation(s)
- Ahmad Al-Shyoukh
- Internal Medicine, University of Missouri-Kansas City l Saint Luke's Health System, Kansas City, USA
| | - Moustafa Younis
- Internal Medicine, University of Missouri-Kansas City l Saint Luke's Health System, Kansas City, USA
| | - Omar Abughanimeh
- Internal Medicine, University of Missouri-Kansas City l Saint Luke's Health System, Kansas City, USA
| | - Mohammad Tahboub
- Internal Medicine, University of Missouri-Kansas City l Saint Luke's Health System, Kansas City, USA
| | - Majdi S Hamarshi
- Critical Care, University of Missouri-Kansas City l Saint Luke's Health System, Kansas City, USA
| |
Collapse
|