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Benallegue N, Beaudonnet F, Husson B, Moshous D, Van Bogaert P, Deiva K. Neurological involvement in secondary hemophagocytic lymphohistiocytosis in children. Eur J Paediatr Neurol 2021; 34:110-117. [PMID: 34482125 DOI: 10.1016/j.ejpn.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/27/2021] [Accepted: 08/15/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe neurological characteristics and CNS involvement on MRI in secondary hemophagocytic lymphohistiocytosis (sHLH) and differentiate it from primary hemophagocytic lymphohistiocytosis (pHLH) and acute disseminated encephalomyelitis (ADEM). METHODS Nine children with sHLH who had neurological symptoms were retrospectively included. Characteristics of brain MRI were compared to those of 15 children with pHLH and neurological involvement and 44 children with ADEM. RESULTS Three children (33%) presented with isolated neurological symptoms. Neurological signs occurred within one month following Epstein-Barr virus primary infection or systemic juvenile arthritis exacerbation in 8 patients (89%). Eight children (89%) had MRI lesions. sHLH MRI lesions were distinct of those of pHLH by morphology and signal with more frequent hyposignal intensities on T1-weighted sequences (p = 0.01) and well-defined and less fuzzy lesions (p = 0.03). All patients survived and one patient presented severe motor and cognitive disability. CONCLUSION Neurological symptoms of sHLH are non-specific and their outcome is favorable in most of the children. MRI at onset may help to differentiate this condition from pHLH.
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Affiliation(s)
- Nail Benallegue
- Pediatric Department, Nantes University Hospital, Nantes, France.
| | - Frédérique Beaudonnet
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Site Bicêtre, Pediatric Neurology Department, National Reference Centre for Rare Inflammatory and Auto-immune Brain and Spinal Diseases, Le Kremlin Bicêtre.
| | - Béatrice Husson
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Site Bicêtre, Pediatric Neurology Department, National Reference Centre for Rare Inflammatory and Auto-immune Brain and Spinal Diseases, Le Kremlin Bicêtre.
| | - Despina Moshous
- Pediatric Immunology, Hematology and Rheumatology Unit, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Laboratory « Genome Dynamics in the Immune System », Imagine Institute Paris, INSERM UMR1163, University of Paris, Paris, France.
| | - Patrick Van Bogaert
- Department of Pediatric Neurology, Angers University Hospital, Angers, France; LARIS Laboratoire Angevin de Recherche en Ingenierie des Systémes, University of Angers, France.
| | - Kumaran Deiva
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Site Bicêtre, Pediatric Neurology Department, National Reference Centre for Rare Inflammatory and Auto-immune Brain and Spinal Diseases, Le Kremlin Bicêtre; UMR1184 « Immunology of Viral Infections and Autoimmune Diseases », CEA, IDMIT, Faculty of Medicine Paris-Saclay, France.
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2
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Amirifar P, Ranjouri MR, Abolhassani H, Moeini Shad T, Almasi-Hashiani A, Azizi G, Moamer S, Aghamohammadi A, Yazdani R. Clinical, immunological and genetic findings in patients with UNC13D deficiency (FHL3): A systematic review. Pediatr Allergy Immunol 2021; 32:186-197. [PMID: 32679608 DOI: 10.1111/pai.13323] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Familial hemophagocytic lymphohistiocytosis (FHL) is a rare autosomal recessive immune disorder that is caused by mutations in 6 different genes related to the formation and function of secretory lysosomes within cytotoxic T lymphocytes and natural killer (NK) cells. Thus, defect in these genes is associated with the accumulation of antigens due to defective cytotoxic function. FHL type 3 (FHL3) accounts for nearly 30-40% of FHL, and its underlying reason is mutation in UNC13D gene which encodes Munc13-4 protein. METHODS For the first time, we aimed to systematically review clinical features, immunologic data, and genetic findings of patients with FHL3. We conducted electronic searches for English-language articles in PubMed, Web of Science, EMBASE, and Scopus databases to collect comprehensive records related to patients with UNC13D mutations. RESULTS A total of 279 abstracts were initially reviewed for inclusion. Among them, 57 articles corresponding to 322 individual FHL3 patients fulfilled our selection criteria. Finally, 73 and 249 patients were considered as severe and mild feature groups, respectively. Our results confirmed that fever, hepatosplenomegaly, and hemophagocytosis are common clinical features in the disease. Moreover, reduced fibrinogen and NK cell activity, as well as increased ferritin and triglycerides, are important markers for early diagnosis of the FHL3 disease. Investigation of genotype showed that the most prevalent type and zygosity of UNC13D are splice-site errors and compound heterozygous, respectively. CONCLUSION FHL3 patients have a wide range of clinical manifestations, which makes it difficult to diagnose. Therefore, it seems that the sequencing of the entire UNC13D gene (coding and non-coding regions) is the most appropriate way to accurate diagnosis of FHL3 patients.
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Affiliation(s)
- Parisa Amirifar
- Department of Medical Genetics, School of Medicine, Tehran University of medical sciences, Tehran, Iran.,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Ranjouri
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Abolhassani
- Research Center for Primary Immunodeficiencies, Iran University of medical sciences, Tehran, Iran.,Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Tannaz Moeini Shad
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Gholamreza Azizi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Soraya Moamer
- School of Public Health, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Yazdani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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3
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Song Y, Pei RJ, Wang YN, Zhang J, Wang Z. Central Nervous System Involvement in Hemophagocytic Lymphohistiocytosis in Adults: A Retrospective Analysis of 96 Patients in a Single Center. Chin Med J (Engl) 2018; 131:776-783. [PMID: 29578120 PMCID: PMC5887735 DOI: 10.4103/0366-6999.228234] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening clinical syndrome. Central nervous system (CNS) involvement is a severe complication, which can lead to rapid disease development and higher morality. However, this has not been given enough attention in adult HLH. Therefore, we carried out this study to analyze the clinical features, laboratory findings, treatment outcomes, and other characteristics of adult HLH with CNS involvement. Methods A retrospective analysis of 96 adult patients with HLH combined with CNS involvement between June 2003 and December 2016 was conducted. Clinical features, cerebrospinal fluid (CSF) features, image changes, and therapeutic outcomes were analyzed. Results Among the 96 patients, 86 had various CNS symptoms and 33 (38.4%) had already presented symptoms before the HLH diagnosis was confirmed. A total of 59 patients received CSF examinations and showed abnormalities in 23 patients (39.0%). Seventy patients received imaging examinations and the results showed fifty patients with imaging changes (71.4%). Fifty-seven patients received multiple rounds of repeated intrathecal injection therapy and 35 patients improved (61.4%). As for the multiple analyses of effective factors on survival time, the results showed that the effects of combined Epstein-Barr virus (EBV) infection (P = 0.026, Exp(B) = 2.309, 95% confidence interval [CI] [1.108, 4.823) and intrathecal injection therapy (P = 0.013, Exp(B) = 0.422, 95% CI [0.214, 0.831]) on the survival time of the CNS-HLH patients were significant. Conclusions Complication with EBV infection is a risk factor, and intrathecal injection is a protective factor. CNS involvement in HLH is not rare, which can result in a poor prognosis. Multiple rounds of repeated intrathecal injection therapy can improve the prognosis of CNS-HLH patients.
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Affiliation(s)
- Yue Song
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Rui-Jun Pei
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yi-Ni Wang
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jia Zhang
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Zhao Wang
- Department of Hematology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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4
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Giardino G, De Luca M, Cirillo E, Palma P, Romano R, Valeriani M, Papetti L, Saunders C, Cancrini C, Pignata C. Two Brothers with Atypical UNC13D-Related Hemophagocytic Lymphohistiocytosis Characterized by Massive Lung and Brain Involvement. Front Immunol 2017; 8:1892. [PMID: 29312353 PMCID: PMC5742579 DOI: 10.3389/fimmu.2017.01892] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/11/2017] [Indexed: 01/05/2023] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal hyperinflammatory condition. Variants in different genes have been associated with the familial forms of the syndrome (FHL), usually presenting within the first 2 years of life. Due to increasing awareness of the signs and symptoms of HLH and a better understanding of the genetic basis of the disease, FHL has been increasingly diagnosed in patients presenting beyond infancy. Here, we report on two brothers with atypical, late-onset HLH in which whole exome sequencing revealed a homozygous pathogenic UNC13D variant. In the first brother, the clinical phenotype was dominated by a massive lung involvement. In the second brother a progressive neurological deterioration was observed. In both cases, the clinical manifestations at symptom onset were misleading, making the diagnosis difficult to achieve. This report expands the spectrum of clinical presentations of FLH3. Moreover, it highlights the importance to warn clinicians to keep a high level of suspicion in patients presenting with fever, cytopenia, splenomegaly of unknown origin, and unresponsiveness to conventional treatment even beyond early childhood. Moreover, this report emphasizes that insidious neurologic symptoms may represent the initial or sole presenting sign of FHL, even in the absence of peripheral signs of activation.
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Affiliation(s)
- Giuliana Giardino
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Maia De Luca
- Unit of Immune and Infectious Diseases, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Rome, Italy
| | - Emilia Cirillo
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Paolo Palma
- Research Unit in Congenital and Perinatal Infection, Unit of Immune and Infectious Diseases, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Rome, Italy
| | - Roberta Romano
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Laura Papetti
- Neurology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Carol Saunders
- Center for Pediatric Genomic Medicine, Children's Mercy-Kansas City, Kansas City, MO, United States.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States.,Department of Pathology, Children's Mercy-Kansas City, Kansas City, MO, United States
| | - Caterina Cancrini
- Unit of Immune and Infectious Diseases, University Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital, Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Claudio Pignata
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
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5
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Gray PE, Shadur B, Russell S, Mitchell R, Buckley M, Gallagher K, Andrews I, Thia K, Trapani JA, Kirk EP, Voskoboinik I. Late-Onset Non-HLH Presentations of Growth Arrest, Inflammatory Arachnoiditis, and Severe Infectious Mononucleosis, in Siblings with Hypomorphic Defects in UNC13D. Front Immunol 2017; 8:944. [PMID: 28848550 PMCID: PMC5552658 DOI: 10.3389/fimmu.2017.00944] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 07/24/2017] [Indexed: 12/13/2022] Open
Abstract
Bi-allelic null mutations affecting UNC13D, STXBP2, or STX11 result in defects of lymphocyte cytotoxic degranulation and commonly cause familial hemophagocytic lymphohistiocytosis (FHL) in early life. Patients with partial loss of function are increasingly being diagnosed after presenting with alternative features of this disease, or with HLH later in life. Here, we studied two sisters with lymphocyte degranulation defects secondary to compound heterozygote missense variants in UNC13D. The older sibling presented aged 11 with linear growth arrest and delayed puberty, 2 years prior to developing transient ischemic attacks secondary to neuroinflammation and hypogammaglobulinemia, but no FHL symptoms. Her geno-identical younger sister was initially asymptomatic but then presented at the same age with severe EBV-driven infectious mononucleosis, which was treated aggressively and did not progress to HLH. The sisters had similar natural killer cell degranulation; however, while cytotoxic activity was moderately reduced in the asymptomatic patient, it was completely absent in both siblings during active disease. Following allogeneic bone marrow transplantation at the age of 15, the older child has completely recovered NK cell cytotoxicity, is asymptomatic, and has experienced an exceptional compensatory growth spurt. Her younger sister was also successfully transplanted and is currently disease free. The current study reveals previously unappreciated manifestations of FHL in patients who inherited hypomorphic gene variants and also raises the important question of whether a threshold of minimum NK function can be defined that should protect a patient from serious disease manifestations such as HLH.
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Affiliation(s)
- Paul Edgar Gray
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Bella Shadur
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Susan Russell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Richard Mitchell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Michael Buckley
- Genetics Laboratory, South Eastern Area Laboratory Services, Randwick, NSW, Australia
| | - Kerri Gallagher
- Department of Immunology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ian Andrews
- Department of Neurology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Kevin Thia
- Cancer Cell Death Laboratory, Cancer Immunology Research, Peter MacCallum Cancer Centre, Melbourne VIC, Australia
| | - Joseph A Trapani
- Cancer Cell Death Laboratory, Cancer Immunology Research, Peter MacCallum Cancer Centre, Melbourne VIC, Australia
| | - Edwin Philip Kirk
- Centre for Clinical Genetics, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Ilia Voskoboinik
- Killer Cell Biology Laboratory, Cancer Immunology Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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6
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Co DO, Bordini BJ, Meyers AB, Inglese C. Immune-Mediated Diseases of the Central Nervous System: A Specificity-Focused Diagnostic Paradigm. Pediatr Clin North Am 2017; 64:57-90. [PMID: 27894452 DOI: 10.1016/j.pcl.2016.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Immune-mediated diseases of the central nervous system show wide variability both symptomatically and with respect to underlying pathophysiology. Recognizing aberrant immunologic activity as the cause of neurologic dysfunction requires establishing as precise a neuroanatomic and functional phenotype as possible, and a diagnostic and therapeutic strategy that stabilizes the patient, excludes broad categories of disease via rapidly available diagnostic assays, and maintains a broad differential diagnosis that includes immune-mediated conditions. This process is aided by recognizing the appropriate clinical circumstances under which immune-mediated disease should be suspected, and how to differentiate these conditions from other causes of similar neurologic dysfunction.
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Affiliation(s)
- Dominic O Co
- Section of Pediatric Rheumatology, Department of Pediatrics, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Brett J Bordini
- Section of Hospital Medicine, Department of Pediatrics, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Arthur B Meyers
- Department of Radiology, University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, USA
| | - Christopher Inglese
- Section of Pediatric Neurology, Department of Neurology, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226, USA
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7
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Murphy C, Nanthapisal S, Gilmour K, Laurent S, D'Arco F, Hemingway C, Brogan P, Eleftheriou D. Progressive neurologic disorder: Initial manifestation of hemophagocytic lymphohistiocytosis. Neurology 2016; 86:2109-11. [PMID: 27164702 PMCID: PMC4891214 DOI: 10.1212/wnl.0000000000002729] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/24/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Claire Murphy
- From the Infection, Immunity, Inflammation and Physiological Medicine Programme (C.M., S.N., P.B., D.E.), University College London Institute of Child Health, UK; Faculty of Medicine (S.N.), Thammasat University, Thailand; Immunology (K.G.), Neuroradiology Department (F.D.), and Neurology Department (C.H.), Great Ormond Street Hospital NHS Foundation Trust, London; and Paediatric Department (S.L.), Royal Free Hospital NHS Foundation Trust, London, UK.
| | - Sira Nanthapisal
- From the Infection, Immunity, Inflammation and Physiological Medicine Programme (C.M., S.N., P.B., D.E.), University College London Institute of Child Health, UK; Faculty of Medicine (S.N.), Thammasat University, Thailand; Immunology (K.G.), Neuroradiology Department (F.D.), and Neurology Department (C.H.), Great Ormond Street Hospital NHS Foundation Trust, London; and Paediatric Department (S.L.), Royal Free Hospital NHS Foundation Trust, London, UK
| | - Kimberly Gilmour
- From the Infection, Immunity, Inflammation and Physiological Medicine Programme (C.M., S.N., P.B., D.E.), University College London Institute of Child Health, UK; Faculty of Medicine (S.N.), Thammasat University, Thailand; Immunology (K.G.), Neuroradiology Department (F.D.), and Neurology Department (C.H.), Great Ormond Street Hospital NHS Foundation Trust, London; and Paediatric Department (S.L.), Royal Free Hospital NHS Foundation Trust, London, UK
| | - Sue Laurent
- From the Infection, Immunity, Inflammation and Physiological Medicine Programme (C.M., S.N., P.B., D.E.), University College London Institute of Child Health, UK; Faculty of Medicine (S.N.), Thammasat University, Thailand; Immunology (K.G.), Neuroradiology Department (F.D.), and Neurology Department (C.H.), Great Ormond Street Hospital NHS Foundation Trust, London; and Paediatric Department (S.L.), Royal Free Hospital NHS Foundation Trust, London, UK
| | - Felice D'Arco
- From the Infection, Immunity, Inflammation and Physiological Medicine Programme (C.M., S.N., P.B., D.E.), University College London Institute of Child Health, UK; Faculty of Medicine (S.N.), Thammasat University, Thailand; Immunology (K.G.), Neuroradiology Department (F.D.), and Neurology Department (C.H.), Great Ormond Street Hospital NHS Foundation Trust, London; and Paediatric Department (S.L.), Royal Free Hospital NHS Foundation Trust, London, UK
| | - Cheryl Hemingway
- From the Infection, Immunity, Inflammation and Physiological Medicine Programme (C.M., S.N., P.B., D.E.), University College London Institute of Child Health, UK; Faculty of Medicine (S.N.), Thammasat University, Thailand; Immunology (K.G.), Neuroradiology Department (F.D.), and Neurology Department (C.H.), Great Ormond Street Hospital NHS Foundation Trust, London; and Paediatric Department (S.L.), Royal Free Hospital NHS Foundation Trust, London, UK
| | - Paul Brogan
- From the Infection, Immunity, Inflammation and Physiological Medicine Programme (C.M., S.N., P.B., D.E.), University College London Institute of Child Health, UK; Faculty of Medicine (S.N.), Thammasat University, Thailand; Immunology (K.G.), Neuroradiology Department (F.D.), and Neurology Department (C.H.), Great Ormond Street Hospital NHS Foundation Trust, London; and Paediatric Department (S.L.), Royal Free Hospital NHS Foundation Trust, London, UK
| | - Despina Eleftheriou
- From the Infection, Immunity, Inflammation and Physiological Medicine Programme (C.M., S.N., P.B., D.E.), University College London Institute of Child Health, UK; Faculty of Medicine (S.N.), Thammasat University, Thailand; Immunology (K.G.), Neuroradiology Department (F.D.), and Neurology Department (C.H.), Great Ormond Street Hospital NHS Foundation Trust, London; and Paediatric Department (S.L.), Royal Free Hospital NHS Foundation Trust, London, UK
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8
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Malaga-Dieguez L, Ming W, Trachtman H. Direct Reversible Kidney Injury in Familial Hemophagocytic Lymphohistiocytosis Type 3. J Am Soc Nephrol 2015; 26:1777-80. [PMID: 25858966 DOI: 10.1681/asn.2014111090] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis is a hyperinflammatory disorder resulting from primary or secondary immune dysfunction. AKI is frequent in severe hemophagocytic lymphohistiocytosis and has been attributed to multiorgan failure or the use of nephrotoxic drugs, but AKI is rarely considered a direct consequence of the disease process. We describe a child with familial hemophagocytic lymphohistiocytosis type 3 who developed AKI requiring prolonged renal replacement therapy because of severe renal inflammation. There was massive infiltration of the renal parenchyma by activated macrophages and cytotoxic T cells, and acute tubular injury. The patient responded to high-dose intravenous methylprednisolone, which resulted in improvement of renal function and discontinuation of renal replacement therapy. This case confirms the occurrence of reversible AKI due to hemophagocytic lymphohistiocytosis-induced activated macrophage infiltration of the renal parenchyma and inflammation.
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Affiliation(s)
| | - Wu Ming
- Pathology, New York University School of Medicine, New York, New York
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9
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Pathophysiology and spectrum of diseases caused by defects in lymphocyte cytotoxicity. Exp Cell Res 2014; 325:10-7. [DOI: 10.1016/j.yexcr.2014.03.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 03/13/2014] [Accepted: 03/17/2014] [Indexed: 01/09/2023]
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10
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Abstract
Haemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory disorder resulting from immune dysfunction reflecting either primary immune deficiency or acquired failure of normal immune homeostasis. Familial HLH includes autosomal recessive and X-linked disorders characterized by uncontrolled activation of T cells and macrophages and overproduction of inflammatory cytokines, secondary to defects in genes encoding proteins involved in granule-dependent cytolytic pathways. In older children and adults, HLH is associated more often with infections, malignancies, autoimmune diseases, and acquired immune deficiencies. HLH, macrophage activation syndrome, sepsis, and systemic inflammatory response syndrome are different clinical entities that probably represent a common immunopathological state, termed cytokine storm. These conditions may be clinically indistinguishable; all include massive inflammatory response, elevated serum cytokine levels, multi-organ involvement, haemophagocytic macrophages, and often death. Tissues of haematopoietic and lymphoid function are directly involved; other organs are secondarily damaged by circulating cytokines and chemokines. Haemophagocytic disorders are now increasingly diagnosed in the context of severe inflammatory reactions to viruses, malignancies and systemic connective tissue diseases. Many of these cases may reflect underlying genetic predispositions to HLH. The detection of gene defects has contributed considerably to our understanding of HLH, but the mechanisms leading to acquired HLH have yet to be fully determined.
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Affiliation(s)
- G Naheed Usmani
- Division of Pediatric Hematology and Oncology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Bruce A Woda
- Department of Pathology, UMass Memorial Medical Center, Worcester, MA, USA
| | - Peter E Newburger
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
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11
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Doménech Abellán E, López Pino M, Solís Muñiz I, García Esparza E. Linfohistiocitosis hemofagocítica familiar: hallazgos neurorradiológicos. RADIOLOGIA 2010; 52:76-80. [DOI: 10.1016/j.rx.2009.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Revised: 10/22/2009] [Accepted: 10/26/2009] [Indexed: 10/20/2022]
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12
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Current World Literature. Curr Opin Allergy Clin Immunol 2009; 9:574-8. [DOI: 10.1097/aci.0b013e328333c13c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Millichap JG. Familial Hemophagocytic Lymphohistiocytosis Type 3 with Demyelinating CNS Disease. Pediatr Neurol Briefs 2009. [DOI: 10.15844/pedneurbriefs-23-2-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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