1
|
Alizadeh Z, Fazlollahi MR, Mazinani M, Badalzadeh M, Heydarlou H, Carapito R, Molitor A, de Oteyza ACG, Proietti M, Bavani MS, Shariat M, Fallahpour M, Movahedi M, Moradi L, Grimbacher B, Bahram S, Pourpak Z. Clinical, immunological and molecular findings of 8 patients with typical and atypical severe combined immunodeficiency: identification of 7 novel mutations by whole exome sequencing. Genes Immun 2023; 24:207-214. [PMID: 37516813 DOI: 10.1038/s41435-023-00215-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 07/31/2023]
Abstract
Severe combined immunodeficiency (SCID) is one of the severe inborn errors of the immune system associated with life-threatening infections. Variations in SCID phenotypes, especially atypical SCID, may cause a significant delay in diagnosis. Therefore, SCID patients need to receive an early diagnosis. Here, we describe the clinical manifestations and genetic results of four SCID and atypical SCID patients. All patients (4 males and 4 females) in early infancy presented with SCID phenotypes within 6 months of birth. The mutations include RAG2 (p.I273T,p.G44X), IL7R (p.F361WfsTer17), ADA (c.780+1G>A), JAK3 (p.Q228Ter), LIG4 (p.G428R), and LAT (p.Y207fsTer33), as well as a previously reported missense mutation in RAG1 (p.A444V). The second report of LAT deficiency in SCID patients is presented in this study. Moreover, all variants were confirmed in patients and their parents as a heterozygous state by Sanger sequencing. The results of our study expand the clinical and molecular spectrum associated with SCID and leaky SCID phenotypes and provide valuable information for the clinical management of the patients.
Collapse
Affiliation(s)
- Zahra Alizadeh
- Immunology, Asthma & Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Fazlollahi
- Immunology, Asthma & Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Mazinani
- Department of Medical Biotechnology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohsen Badalzadeh
- Immunology, Asthma & Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanieh Heydarlou
- Immunology, Asthma & Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Raphael Carapito
- Laboratoire d'ImmunoRhumatologie Moléculaire, plateforme GENOMAX, INSERM UMR_S 1109, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), LabEx TRANSPLANTEX, Université de Strasbourg, Strasbourg, France
- Service d'Immunologie Biologique, Plateau Technique de Biologie, Pôle de Biologie, Nouvel Hôpital Civil, 1 place de l'Hôpital, 67091, Strasbourg, France
| | - Anne Molitor
- Laboratoire d'ImmunoRhumatologie Moléculaire, plateforme GENOMAX, INSERM UMR_S 1109, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), LabEx TRANSPLANTEX, Université de Strasbourg, Strasbourg, France
- Service d'Immunologie Biologique, Plateau Technique de Biologie, Pôle de Biologie, Nouvel Hôpital Civil, 1 place de l'Hôpital, 67091, Strasbourg, France
| | - Andrés Caballero Garcia de Oteyza
- Department of Rheumatology and Clinical Immunology, Hannover Medical School, Hannover, Germany
- RESIST - Cluster of Excellence 2155, Hannover Medical School, Hannover, Germany
| | - Michele Proietti
- Department of Rheumatology and Clinical Immunology, Hannover Medical School, Hannover, Germany
- RESIST - Cluster of Excellence 2155, Hannover Medical School, Hannover, Germany
- DZIF - German Center for Infection Research, Satellite Center Freiburg, Freiburg, Germany
| | - Maryam Soleimani Bavani
- Immunology, Asthma & Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Shariat
- Department of Allergy and Clinical Immunology, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Fallahpour
- Department of Allergy and Clinical Immunology, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Movahedi
- Department of Allergy and Clinical Immunology, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Moradi
- Immunology, Asthma & Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bodo Grimbacher
- Department of Rheumatology and Clinical Immunology, Hannover Medical School, Hannover, Germany
- RESIST - Cluster of Excellence 2155, Hannover Medical School, Hannover, Germany
- DZIF - German Center for Infection Research, Satellite Center Freiburg, Freiburg, Germany
| | - Seiamak Bahram
- Laboratoire d'ImmunoRhumatologie Moléculaire, plateforme GENOMAX, INSERM UMR_S 1109, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), LabEx TRANSPLANTEX, Université de Strasbourg, Strasbourg, France.
- Service d'Immunologie Biologique, Plateau Technique de Biologie, Pôle de Biologie, Nouvel Hôpital Civil, 1 place de l'Hôpital, 67091, Strasbourg, France.
| | - Zahra Pourpak
- Immunology, Asthma & Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
2
|
Pan Y, Pan H, Lian C, Wu B, Lin J, Huang G, Cui B. Case Report: Mutations in JAK3 causing severe combined immunodeficiency complicated by disseminated Bacille Calmette-Guérin disease and Pneumocystis pneumonia. Front Immunol 2022; 13:1055607. [PMID: 36466884 PMCID: PMC9712176 DOI: 10.3389/fimmu.2022.1055607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/26/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As a form of severe combined immunodeficiency (SCID), Janus kinase 3 (JAK3) deficiency can be fatal during severe infections in children, especially after inoculation of live-attenuated vaccines. We report a unique case of JAK3 deficiency with two compound heterozygous JAK3 mutations complicated by disseminated Bacille Calmette-Guérin (BCG) disease and Pneumocystis pneumonia. CASE DESCRIPTION A 5-month-old Chinese girl presented with recurring fever and productive cough after BCG vaccination and ineffective antibiotic treatment. Chest CT demonstrated bilateral infiltrations, enlarged mediastinal and axillary lymph nodes, and hypoplasia of the thymus. Mycobacterium tuberculosis and Pneumocystis jirovecii were detected from blood samples by sequencing. Acid-fast bacilli were also found from the sputum aspirate and gastric aspirate. Lymphocyte subset analyses indicated T-B+NK- immunodeficiency, and gene sequencing identified two heterozygous missense mutations (one unreported globally) in the Janus homology 7 (JH7) domain of JAK3. The patient received rifampicin, isoniazid, ethambutol, and trimethoprim/sulfamethoxazole and was discharged after improvements but against advice. OUTCOME The patient died at 13 months of age due to severe infections and hepatic damage. DISCUSSION SCID should be recognized before inoculation of live-attenuated vaccines in children. Newborn screening for SCID is advocated. Further investigations are needed to better understand the pathogenicity of the variants and molecular mechanism of the JH7 domain of JAK3.
Collapse
Affiliation(s)
- Ying Pan
- The Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Hui Pan
- The Outpatient Department, Shantou Longhu People’s Hospital, Shantou, Guangdong, China
- The Clinical Research Unit, Shantou University Medical College, Shantou, Guangdong, China
| | - Chunan Lian
- The Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Beiyan Wu
- The Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jieying Lin
- The Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Guang Huang
- The Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Binglin Cui
- The Department of Pediatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
- *Correspondence: Binglin Cui,
| |
Collapse
|
3
|
Shi B, Chen M, Xia Z, Xiao S, Tang W, Qin C, Cheng Y, Huang T, Huang C, Li Y, Xu H. Hemophagocytic syndrome associated with Mycobacterium bovis in a patient with X-SCID: a case report. BMC Infect Dis 2020; 20:711. [PMID: 32993535 PMCID: PMC7525942 DOI: 10.1186/s12879-020-05421-9] [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] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023] Open
Abstract
Background Mycobacterium bovis could infect patients with immunodeficiency or immunosuppressive conditions via Bacillus Calmette-Guérin (BCG) vaccination. Tuberculosis-related hemophagocytic syndrome (HPS) is reported, but not HPS caused by Mycobacterium bovis in children. Case presentation A 4-month Chinese boy presented fever and cough. The initial laboratory investigation showed the lymphocyte count of 0.97 × 109/L, which decreased gradually. HPS was diagnosed based on the test results that fulfilled the HLH-2004 criteria. In addition, Mycobacterium tuberculosis complex was detected from his peripheral blood via metagenomic next-generation sequencing (mNGS) and M. bovis was identified by polymerase chain reaction-reverse dot blot (PCR-RDB). Thus, the patient was treated with Isoniazid, Rifampin, and Pyrazinamide, but not improved. However, parents refused to accept further therapy, and was discharged on the day 12 of admission. To confirm the pathogenesis, genetic analysis was performed. Mutation in the interleukin-2 receptor subunit gamma gene: Exon 6: c.854G > A; p. Arg285Gln was detected in the patient and the mother, which could underlie X-linked severe combined immunodeficiency. Conclusions A boy with X-SCID was diagnosed with M. bovis-associated HPS, emphasizing that X-SCID should be considered when M. bovis is detected in a male infant with low lymphocyte counts.
Collapse
Affiliation(s)
- Buyun Shi
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Ming Chen
- Department of Dermatology, Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Zhi Xia
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Shuna Xiao
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Wen Tang
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Chenguang Qin
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Ying Cheng
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Tao Huang
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Chengjiao Huang
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Yong Li
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China
| | - Hui Xu
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province (Women and Children's Hospital of Hubei Province), NO.745 Wu LuoRoad, Hongshan District, Wuhan City, 430070, Hubei Province, China.
| |
Collapse
|