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Honsali R, Tahiri L, Cherkaoui-Dekkaki S, Allali F. Rheumatological manifestations of H syndrome. Reumatologia 2024; 62:294-303. [PMID: 39381726 PMCID: PMC11457316 DOI: 10.5114/reum/191751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/29/2024] [Indexed: 10/10/2024] Open
Abstract
H syndrome (HS) is a rare autosomal recessive genodermatosis characterised by cutaneous hyperpigmentation, hypertrichosis, sclerodermatous thickening, and multisystemic involvement. It results from mutations in the SLC29A3 gene encoding the human equilibrative nucleoside transporter 3, leading to impaired histiocyte apoptosis and unchecked proliferation. We report the case of a 24-year-old Moroccan male who had a history of insulin-dependent diabetes mellitus. He developed hyperpigmented skin patches with hypertrichosis and induration. Musculoskeletal findings included bilateral hallux valgus, pes planus, reducible flexion contractures of the proximal interphalangeal joints, and restricted ankle dorsiflexion. Additional findings consist of lymphadenopathy, hepatomegaly, hypogonadism, and ophthalmic manifestations. Investigations showed elevated sedimentation rate, anaemia, and osteopaenia. Ankle ultrasound revealed calcaneal enthesopathy and subcutaneous infiltration. In reporting this case, we aim to highlight the significant rheumatological involvement that can arise in patients with H syndrome and explore potential treatment options to improve the musculoskeletal findings.
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Affiliation(s)
- Rahma Honsali
- Rheumatology Department B, Al Ayachi Hospital, Ibn Sina Hospital Centre, Mohammed V University, Rabat, Morocco
| | - Latifa Tahiri
- Rheumatology Department B, Al Ayachi Hospital, Ibn Sina Hospital Centre, Mohammed V University, Rabat, Morocco
| | | | - Fadoua Allali
- Rheumatology Department B, Al Ayachi Hospital, Ibn Sina Hospital Centre, Mohammed V University, Rabat, Morocco
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Al-Haddab M, Al Muqarrab FJ, Alhumidi A, Alkofide M. Clinical Progression and Manifestations of H Syndrome: A Case Report of Failed Treatment Option. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e944198. [PMID: 38850017 PMCID: PMC11176275 DOI: 10.12659/ajcr.944198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/16/2024] [Accepted: 04/09/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND H syndrome is an autosomal recessive disorder of histiocytic proliferation with clinical spectrum of unique cutaneous and systemic manifestations. There is no consistent treatment for the disease, and all available options are based on case reports. Here, we present the chronological progression of a case of H syndrome with typical cutaneous manifestations that was misdiagnosed early as meningitis-induced sensorineural hearing loss and later as a non-defined autoimmune connective tissue disease. A new tried, although failed, treatment option is described as well. CASE REPORT A 31-year-old Saudi woman born of a consanguineous marriage presented to our dermatology clinic with symmetrical indurated hyperpigmented to violaceous plaques over the medial thighs, upper legs, lower back, volar wrists, and upper arms, associated with hypertrichosis. Hallux valgus of the big toes was clinically detected as well. She had a history of sensorineural deafness, diabetes mellitus, chronic anemia, and hypothyroidism. Genetic analysis of the patient showed a homozygous frameshift pathogenic variant of the SLC29A3 gene, c.243del p.(Lys81Asnfs*20). Systemic treatments in the form of methotrexate and imatinib had been tried; however, both failed to control her sclerotic cutaneous changes. CONCLUSIONS Knowing the early life presentation and the variable clinical symptoms of H syndrome is crucial in early intervention and further prevention of the non-reversible changes. Moreover, avoiding unnecessary immunosuppressive medication use is warranted in certain circumstances.
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Affiliation(s)
- Mohammed Al-Haddab
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fatimah J. Al Muqarrab
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Alhumidi
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Maha Alkofide
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Kose H, Baskaya MD, Kilic SS. Cases with the H syndrome presenting with skin and bone findings. Australas J Dermatol 2024; 65:337-341. [PMID: 38421823 DOI: 10.1111/ajd.14235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 01/27/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The H syndrome is an autosomal recessive disease characterized by hyperpigmentation, hypertrichosis and sensorineural hearing loss. METHODS A mutation in the coding of the human equilibrative nucleoside transporter 3 (hENT3) within the SLC29A3 gene on chromosome 10q22 leads to the manifestation of this disease. In this report, we present two cases of H syndrome. RESULTS The first patient exhibits hyperpigmentation, hypogonadism, Type 1 diabetes mellitus, arthritis and osteoporosis. The second patient experiences hyperpigmentation, hypertrichosis, osteopenia and hypogonadism. CONCLUSION Our objective is to broaden the clinical spectrum of H syndrome, highlighting the involvement of arthritis, hyperinflammation and low bone mineral density in individuals with this disorder.
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Affiliation(s)
- Hulya Kose
- Department of Pediatric Immunology and Rheumatology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Merve Deniz Baskaya
- Department of Pediatric Immunology and Rheumatology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Sara Sebnem Kilic
- Department of Pediatric Immunology and Rheumatology, Uludag University Faculty of Medicine, Bursa, Turkey
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Tesser A, Valencic E, Boz V, Tornese G, Pastore S, Zanatta M, Tommasini A. Rheumatological complaints in H syndrome: from inflammatory profiling to target treatment in a case study. Pediatr Rheumatol Online J 2024; 22:21. [PMID: 38263041 PMCID: PMC10807099 DOI: 10.1186/s12969-023-00950-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND H Syndrome is a rare genetic condition caused by biallelic pathogenic variants in the SLC29A3 gene. It is characterized by a wide range of clinical manifestations, many of which are related to the immune-rheumatological field. These include scleroderma-like skin changes, deforming arthritis, and enlarged lymph nodes. The condition also features cardiac and endocrine defects, as well as hearing loss, for which the immune pathogenesis appears less clear. Immunomodulatory medications have been shown to improve many symptoms in recent experiences. CASE PRESENTATION A 21-year-old girl was referred to our institute after being diagnosed with H syndrome. Her medical history was characterized by the development of finger and toe deformities, which developed since the first years of life and progressively worsened with clinodactyly. At 6 years of age, she was diagnosed with diabetes mellitus without typical autoantibodies and with bilateral sensorineural hearing loss. She also complained of frequent episodes of lymphadenopathy, sometimes with colliquation and growth retardation due to pancreatic insufficiency. It wasn't until the genetic diagnosis of H syndrome that the continual increase in acute phase reactants was noticed, suggesting that an immunological pathogenesis may be the source of her problems. During her visit to our institute, she reported serious pain in both feet and hands and difficulty walking due to knee arthritis and muscle contractures. Conventional therapy with steroid injection in affected joints and methotrexate only led to partial improvement. After a thorough assessment of her inflammatory profile showing a high interferon score, the girl received treatment with baricitinib. Furthermore, based on recent data showing that SLC29A3 deficiency results in interferon production because of Toll-like Receptor 7 activation in lysosomes, hydroxychloroquine was also added. The combination of the two drugs resulted for the first time in a rapid and persistent normalization of inflammatory markers, paralleled by a dramatic improvement in symptoms. CONCLUSIONS We describe the results of inhibiting IFN inflammation in H syndrome and discuss how JAK inhibitors and antimalarials might represent a mechanistically based treatment for this orphan drug disorder.
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Affiliation(s)
- Alessandra Tesser
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria 65/1, Trieste, 34137, Italy
| | - Erica Valencic
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria 65/1, Trieste, 34137, Italy.
| | - Valentina Boz
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria 65/1, Trieste, 34137, Italy
| | - Gianluca Tornese
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria 65/1, Trieste, 34137, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, Trieste, 34149, Italy
| | - Serena Pastore
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria 65/1, Trieste, 34137, Italy
| | - Manuela Zanatta
- Centro di Coordinamento Regionale Malattie Rare ASUFC, Piazzale Santa Maria della Misericordia, Udine, 33100, Italy
| | - Alberto Tommasini
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria 65/1, Trieste, 34137, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, Trieste, 34149, Italy
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