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Kadi Ozan Z, Erduran E, Ceylaner S, Aslan Y, Bahadir A, Reis GP, Mutlu M. Familial Hemophagocytic Lymphohistiocytosis Screening in Neonatal Sepsis. J Pediatr Hematol Oncol 2024; 46:e393-e401. [PMID: 38968556 DOI: 10.1097/mph.0000000000002906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/15/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE Neonatal sepsis and familial hemophagocytic lymphohistiocytosis (fHLH) have similar clinical and laboratory symptoms and the possibility of overlooking fHLH diagnosis is high in newborns with sepsis. History of consanguineous marriage and/or sibling death, hepatomegaly/splenomegaly, and hyperferritinemia (>500 ng/mL) are likely to support fHLH in newborns with sepsis. Therefore, in newborns with sepsis in whom at least 2 of these 3 criteria were detected, genetic variants was investigated for the definitive diagnosed of fHLH. According to the results of genetic examination, we investigated whether these criteria supporting fHLH could be used as a screening test in fHLH. MATERIALS AND METHODS fHLH-associated genetic variants were investigated in 22 patients diagnosed with neonatal sepsis who fulfilled at least 2 of the following criteria (1) history of consanguineous marriage and/or sibling death, (2) hepatomegaly/splenomegaly, and (3) hyperferritinemia (>500 ng/mL). RESULTS Heterozygous variants were determined in 6 patients (27.2%): 3 STXBP2 , 1 STX11 , 1 UNC13D , and 1 PRF1 . Polymorphisms associated with the clinical symptoms and signs of HLH were determined in 5 patients (22.7%): 4 UNC13D , 1 PRF1 . Two patients were in the heterozygous variants and polymorphism associated with the clinical symptoms and signs of HLH groups. In 12 patients, benign polymorphisms were detected in STXBP2 and UNC13D genes. No change in fHLH associated genes were found in 1 patient. CONCLUSION Some variants and/or polymorphisms identified in our patients have been previously reported in patients with HLH. Therefore, we recommend further investigation of fHLH in patients with neonatal sepsis who fulfill at least 2 of the above 3 criteria.
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Affiliation(s)
| | - Erol Erduran
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon
| | - Serdar Ceylaner
- Intergen Genetics and Rare Diseases Diagnosis Center, Ankara
| | - Yakup Aslan
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Aysenur Bahadir
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon
| | - Gokce P Reis
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon
| | - Mehmet Mutlu
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Elgaali E, Mezzavilla M, Ahmed I, Elanbari M, Ali A, Abdelaziz G, Fakhro KA, Saleh A, Ben-Omran T, Almulla N, Cugno C. Genetic background of primary and familial HLH in Qatar: registry data and population study. Front Pediatr 2024; 12:1326489. [PMID: 38808104 PMCID: PMC11130942 DOI: 10.3389/fped.2024.1326489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/08/2024] [Indexed: 05/30/2024] Open
Abstract
Background Familial hemophagocytic lymphohistiocytosis (FHLH) is an inherited life-threatening disease. Five types are identified, with the addition of congenital immunodeficiency syndromes in which HLH is a typical manifestation. The literature on this disease is very scarce in the Middle East, with only a few scattered reports. Methods We report detailed demographic, clinical, and genomic data from 28 patients diagnosed with primary and familial HLH over the last decade in Qatar. An evaluation was performed of allele frequencies of deleterious variants from 12 primary and familial HLH causative genes on the Qatar Genome Programme (QGP) cohort of 14,669 Qatari individuals. Results The genetic diagnosis was obtained in 15 patients, and four novel mutations in Perforin 1 (PRF1), UNC13D, LYST, and RAB27A genes were found. We identified 22,945 low/high/moderate/modifier impact variants significantly enriched in the QGP in those 12 genes. The variants rs1271079313 in PRF1 and rs753966933 in RAB27A found in our patient cohort were significantly more prevalent in the QGP compared to the Genome Aggregation Database (gnomAD) database, with a high carrier frequency in the Qatari population. Conclusions We established the first primary and familial HLH Registry in the Gulf Region and identified novel possibly pathogenic variants present at higher frequency in the Qatari population, which could be used for screening purposes. Raising awareness about primary and familial HLH and implementing screening activities in the Qatari highly inbred population could stem into more comprehensive premarital and prenatal evaluations and faster diagnosis.
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Affiliation(s)
- Elkhansa Elgaali
- Pediatric Hematology and Oncology Department, Sidra Medicine, Doha, Qatar
| | | | - Ikhlak Ahmed
- Research Department, Sidra Medicine, Doha, Qatar
| | | | - Aesha Ali
- Research Department, Sidra Medicine, Doha, Qatar
| | | | | | - Ayman Saleh
- Pediatric Hematology and Oncology Department, Sidra Medicine, Doha, Qatar
| | - Tawfeg Ben-Omran
- Division of Genetic and Genomic Medicine, Sidra Medicine, Doha, Qatar
- Department of Medical Genetics, Hamad Medical Corporation, Doha, Qatar
| | - Naima Almulla
- Pediatric Hematology and Oncology Department, Sidra Medicine, Doha, Qatar
| | - Chiara Cugno
- Pediatric Hematology and Oncology Department, Sidra Medicine, Doha, Qatar
- Research Department, Sidra Medicine, Doha, Qatar
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Morimoto M, Nicoli ER, Kuptanon C, Roney JC, Serra-Vinardell J, Sharma P, Adams DR, Gallin JI, Holland SM, Rosenzweig SD, Barbot J, Ciccone C, Huizing M, Toro C, Gahl WA, Introne WJ, Malicdan MCV. Spectrum of LYST mutations in Chediak-Higashi syndrome: a report of novel variants and a comprehensive review of the literature. J Med Genet 2024; 61:212-223. [PMID: 37788905 DOI: 10.1136/jmg-2023-109420] [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: 05/23/2023] [Accepted: 09/10/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION Chediak-Higashi syndrome (CHS) is a rare autosomal recessive disorder characterised by partial oculocutaneous albinism, a bleeding diathesis, immunological dysfunction and neurological impairment. Bi-allelic loss-of-function variants in LYST cause CHS. LYST encodes the lysosomal trafficking regulator, a highly conserved 429 kDa cytoplasmic protein with an unknown function. METHODS To further our understanding of the pathogenesis of CHS, we conducted clinical evaluations on individuals with CHS enrolled in our natural history study. Using genomic DNA Sanger sequencing, we identified novel pathogenic LYST variants. Additionally, we performed an extensive literature review to curate reported LYST variants and classified these novel and reported variants according to the American College of Medical Genetics/Association for Molecular Pathology variant interpretation guidelines. RESULTS Our investigation unveiled 11 novel pathogenic LYST variants in eight patients with a clinical diagnosis of CHS, substantiated by the presence of pathognomonic giant intracellular granules. From these novel variants, together with a comprehensive review of the literature, we compiled a total of 147 variants in LYST, including 61 frameshift variants (41%), 44 nonsense variants (30%), 23 missense variants (16%), 13 splice site variants or small genomic deletions for which the coding effect is unknown (9%), 5 in-frame variants (3%) and 1 start-loss variant (1%). Notably, a genotype-phenotype correlation emerged, whereby individuals harbouring at least one missense or in-frame variant generally resulted in milder disease, while those with two nonsense or frameshift variants generally had more severe disease. CONCLUSION The identification of novel pathogenic LYST variants and improvements in variant classification will provide earlier diagnoses and improved care to individuals with CHS.
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Affiliation(s)
- Marie Morimoto
- NIH Undiagnosed Diseases Program, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elena-Raluca Nicoli
- NIH Undiagnosed Diseases Program, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Chulaluck Kuptanon
- Human Biochemical Genetics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Joseph C Roney
- Human Biochemical Genetics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jenny Serra-Vinardell
- Human Biochemical Genetics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Prashant Sharma
- NIH Undiagnosed Diseases Program, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - David R Adams
- NIH Undiagnosed Diseases Program, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
- Office of the Clinical Director, National Institutes of Health, Bethesda, Maryland, USA
| | - John I Gallin
- Clinical Pathophysiology Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Steven M Holland
- Immunopathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Sergio D Rosenzweig
- Department of Laboratory Medicine, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Jose Barbot
- Unidade de Hematologia, Serviço de Pediatria, Centro Hospitalar do Porto, Porto, Portugal
| | - Carla Ciccone
- Human Biochemical Genetics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marjan Huizing
- Human Biochemical Genetics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Camilo Toro
- NIH Undiagnosed Diseases Program, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - William A Gahl
- NIH Undiagnosed Diseases Program, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
- Human Biochemical Genetics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Wendy J Introne
- Human Biochemical Genetics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - May Christine V Malicdan
- NIH Undiagnosed Diseases Program, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
- Human Biochemical Genetics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
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Rahman AU, Baig F, Javid Chaudhary UI, Ashraf MB, Jawaid MD, Chaudary A, Tariq M. Hemophagocytic Lymphohistiocytosis Associated With Human Herpesvirus-6 (HHV-6) Infection in an Immunocompetent Adult: A Case Report. Cureus 2024; 16:e54299. [PMID: 38496135 PMCID: PMC10944635 DOI: 10.7759/cureus.54299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder characterized by extreme immune activation and excessive inflammation. It has been reported in patients with familial cases, immunodeficiencies, malignancies, stem cell transplants, and viral etiologies. This report describes acquired HLH associated with Human herpesvirus-6 (HHV-6) infection in a 76-year-old previously healthy male. The patient was admitted to the hospital due to fever, chills, and abdominal pain. The diagnostic workup revealed gallbladder wall thickening on imaging, concerning for cholecystitis. The patient was started on treatment for sepsis. Further clinical deterioration led to an extensive infectious workup. The patient was found to have elevated soluble IL-2Ra levels, and a bone marrow biopsy was performed, which revealed HLH. A positive HHV-6 polymerase chain reaction in the cerebrospinal fluid and serum confirmed the viral infection. Treatment involved the initiation of high-dose steroids, etoposide, and ganciclovir. Despite these interventions, the patient's clinical status worsened, leading to the implementation of comfort measures, and the patient eventually died. This case underscores the importance of considering HHV-6 as a potential cause of HLH in immunocompetent adults. From this case, we infer that a heightened level of vigilance is necessary to recognize and intervene in this challenging condition promptly.
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Affiliation(s)
- Ateeb Ur Rahman
- Department of Internal Medicine, Penn State Health, Camp Hill, USA
| | - Fahad Baig
- Department of Medicine, Rashid Latif Medical College, Lahore, PAK
| | | | | | | | - Amna Chaudary
- Department of Internal Medicine, Penn State Health, Camp Hill, PAK
| | - Munim Tariq
- Department of Internal Medicine, The Rotherham NHS Foundation Trust, Sheffield, GBR
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Al-Mousa H, Barbouche MR. Genetics of Inborn Errors of Immunity in highly consanguineous Middle Eastern and North African populations. Semin Immunol 2023; 67:101763. [PMID: 37075586 DOI: 10.1016/j.smim.2023.101763] [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] [Indexed: 04/21/2023]
Abstract
Consanguineous marriages in Middle Eastern and North African (MENA) countries are deeply-rooted tradition and highly prevalent resulting into increased prevalence of autosomal recessive diseases including Inborn Errors of Immunity (IEIs). Molecular genetic testing is an important diagnostic tool for IEIs since it provides a definite diagnosis, genotype-phenotype correlation, and guide therapy. In this review, we will discuss the current state and challenges of genomic and variome studies in MENA region populations, as well as the importance of funding advanced genome projects. In addition, we will review the MENA underlying molecular genetic defects of over 2457 patients published with the common IEIs, where autosomal recessive mode of inheritance accounts for 76% of cases with increased prevalence of combined immunodeficiency diseases (50%). The efforts made in the last three decades in terms of international collaboration and of in situ capacity building in MENA region countries led to the discovery of more than 150 novel genes involved in IEIs. Expanding sequencing studies within the MENA will undoubtedly be a unique asset for the IEI genetics which can advance research, and support precise genomic diagnostics and therapeutics.
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Affiliation(s)
- Hamoud Al-Mousa
- Section of Allergy and Immunology, Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Mohamed-Ridha Barbouche
- Department of Microbiology, Immunology and Infectious Diseases, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.
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AlAhmari A, Khogeer H. Successful use of emapalumab in refractory hemophagocytic lymphohistiocytosis in a child with Chédiak-Higashi syndrome: a case report. J Med Case Rep 2023; 17:113. [PMID: 36978158 PMCID: PMC10049777 DOI: 10.1186/s13256-023-03808-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 02/06/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Hemophagocytic lymphohistiocytosis is a life-threatening disease heralded by fever, cytopenia, hepatosplenomegaly, and multisystem organ failure. Its association with genetic mutations, infections, autoimmune disorders, and malignancies is widely reported. CASE PRESENTATION A 3-year-old male Arab Saudi patient with insignificant past medical history and parental consanguinity presented with abdominal distension of moderate severity and persistent fever despite receiving antibiotics. This was accompanied by hepatosplenomegaly and silvery hair. The clinical and biochemical profiles were suggestive of Chédiak-Higashi syndrome with hemophagocytic lymphohistiocytosis. The patient received the hemophagocytic lymphohistiocytosis-2004 chemotherapy protocol and had multiple hospital admissions mainly due to infections and febrile neutropenia. After achieving the initial remission, the patient's disease reactivated and did not respond to reinduction with the hemophagocytic lymphohistiocytosis-2004 protocol. Due to the disease reactivation and intolerance of conventional therapy, the patient commenced emapalumab. The patient was successfully salvaged and underwent an uneventful hematopoietic stem cell transplantation. CONCLUSIONS Novel agents such as emapalumab can be helpful for the management of refractory, recurrent, or progressive disease, while avoiding the toxicities of conventional therapy. Due to a paucity of available data on emapalumab, additional data are needed to establish its role in hemophagocytic lymphohistiocytosis treatment.
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Affiliation(s)
- Ali AlAhmari
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center, PO Box 3354, Riyadh, 11211, Saudi Arabia.
- College of Medicine, AlFaisal University, Riyadh, Saudi Arabia.
| | - Haitham Khogeer
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
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Alsohime F, Temsah MH, Alotaibi RM, Alhalabi RM, AlEnezy S, Yousef AA, Alzaydi AM, Inany HS, Al-Eyadhy A, Almazyad M, Alharbi A, Alsoqati AA, Andijani A, Abu Ghazal M, El Masri K, Doussouki M, Butt RF, Alshehri S, Alsatrawi M, Macarambon J, Hasan GM, Alsultan A. Presentations and outcomes of familial hemophagocytic lymphohistiocytosis in the pediatric intensive care units (PICUs). Front Pediatr 2023; 11:1152409. [PMID: 37144147 PMCID: PMC10151775 DOI: 10.3389/fped.2023.1152409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/30/2023] [Indexed: 05/06/2023] Open
Abstract
Objectives We aimed to describe Familial Hemophagocytic Lymphohistiocytosis (F-HLH) patients' clinical features, intensive care courses, and outcomes. Methods Multi-center retrospective cohort study of pediatric patients diagnosed with F-HLH from 2015 to 2020 in five tertiary centers in Saudi Arabia. Patients were classified as F-HLH based on their genetic confirmation of known mutation or on their clinical criteria, which include a constellation of abnormalities, early disease onset, recurrent HLH in the absence of other causes, or a family history of HLH. Results Fifty-eight patients (28 male, 30 female), with a mean age of 21.0 ± 33.9 months, were included. The most common principal diagnosis was hematological or immune dysfunction (39.7%), followed by cardiovascular dysfunction in 13 (22.4%) patients. Fever was the most common clinical presentation in 27.6%, followed by convulsions (13.8%) and bleeding (13.8%). There were 20 patients (34.5%) who had splenomegaly, and more than 70% of patients had hyperferritinemia >500 mg/dl, hypertriglyceridemia >150 mg/dl and hemophagocytosis in bone marrow biopsy. Compared to deceased patients 18 (31%), survivors had significantly lower PT (p = 041), bilirubin level of <34.2 mmol/L (p = 0.042), higher serum triglyceride level (p = 0.036), and lesser bleeding within the initial 6 h of admission (p = 0.004). Risk factors for mortality included requirements of higher levels of hemodynamic (61.1% vs. 17.5%, p = 0.001) and respiratory (88.9% vs. 37.5%, p < 0.001) support, and positive fungal cultures (p = 0.046). Conclusions Familial HLH still represents a challenge in the pediatric critical care setting. Earlier diagnosis and prompt initiation of appropriate treatment could improve F-HLH survival.
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Affiliation(s)
- Fahad Alsohime
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohamad-Hani Temsah
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, Riyadh, Saudi Arabia
- Prince Abdullah bin Khaled Coeliac Disease Research Chair, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Correspondence: Mohamad-Hani Temsah
| | - Rawan M. Alotaibi
- College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Reham M. Alhalabi
- College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Sarah AlEnezy
- College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Aly Abdelrahman Yousef
- Division of Pediatric Critical Care, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Pediatrics, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Abdullah Mohammed Alzaydi
- Division of Pediatric Critical Care, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Hussam Sameer Inany
- Division of Pediatric Critical Care, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ayman Al-Eyadhy
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohammed Almazyad
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ali Alharbi
- Pediatric Critical Care Division, Specialized Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Abdullah Alsoqati
- Pediatric Critical Care Division, Specialized Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdurahman Andijani
- Pediatric Critical Care Division, Specialized Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Abu Ghazal
- Pediatric Critical Care Division, Specialized Children Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Kamal El Masri
- Pediatric Intensive Care Unit, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Maher Doussouki
- Pediatric Hematology & Oncology Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Raheel Farooq Butt
- Pediatric Critical Care Division, King Saud Medical City, Riyadh, Saudi Arabia
| | - Saleh Alshehri
- Pediatric Critical Care Division, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mohammed Alsatrawi
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Jaramia Macarambon
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Gamal M. Hasan
- Pediatric Department, Assiut Faculty of Medicine, Assiut University, Assiut, Egypt
- Pediatric Department, Pediatric Intensive Care Unit, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Abdulrahman Alsultan
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Oncology Center, King Saud University Medical City, Riyadh, Saudi Arabia
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Celebi Congur E, Dalgic N, Ada HI, Türksoy F, Yıldırmak ZY. Diagnostic challenges during the COVID-19 pandemic: A child with tuberculosis-induced haemophagocytic lymphohistiocytosis misdiagnosed as multi-inflammatory syndrome in children. J Paediatr Child Health 2022; 58:2305-2307. [PMID: 35986696 PMCID: PMC9538269 DOI: 10.1111/jpc.16160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Emel Celebi Congur
- Division of Pediatric Infectious DiseasesSisli Hamidiye Etfal Training and Research Hospital, University of Health SciencesIstanbulTurkey
| | - Nazan Dalgic
- Division of Pediatric Infectious DiseasesSisli Hamidiye Etfal Training and Research Hospital, University of Health SciencesIstanbulTurkey
| | - Halil I Ada
- Division of RadiologySisli Hamidiye Etfal Training and Research Hospital, University of Health SciencesIstanbulTurkey
| | - Fazilet Türksoy
- Division of PediatricsSisli Hamidiye Etfal Training and Research Hospital, University of Health SciencesIstanbulTurkey
| | - Zeynep Y Yıldırmak
- Division of Pediatric Hematology and OncologySisli Hamidiye Etfal Training and Research Hospital, University of Health SciencesIstanbulTurkey
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Caldirola MS, Raccio AG, Giovanni DD, Gaillard MI, Preciado MV. Pediatric inborn errors of immunity causing hemophagocytic lymphohistiocytosis: Case report and review of the literature. J Leukoc Biol 2022; 112:607-615. [PMID: 35899932 DOI: 10.1002/jlb.5mr0622-037r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/28/2022] [Indexed: 11/07/2022] Open
Abstract
Inborn errors of immunity are a group of genetic disorders caused by mutations that affect the development and/or function of several compartments of the immune system, predisposing patients to infections, autoimmunity, allergy and malignancies. In this regard, mutations that affect proteins involved in trafficking, priming, docking, or membrane fusion will impair the exocytosis of lytic granules of effector NK and cytotoxic T lymphocytes. This may predispose patients to hemophagocytic lymphohistiocytosis, a life-threatening immune disorder characterized by systemic lymphocyte and macrophage activation, and increased levels of cytokines, which lead to an uncontrolled hyperinflammation state and progressive multiorgan damage. In this review, we will describe a clinical case and recent advances in inborn errors of immunity predisposing to hemophagocytic lymphohistiocytosis. Summary sentence: Review of recent advances in inborn errors of immunity predisposing to hemophagocytic lymphohistiocytosis.
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Affiliation(s)
- María Soledad Caldirola
- Servicio Inmunología, Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP- CONICET-GCBA)- Hospital de Niños "Dr. Ricardo Gutiérrez,", Buenos Aires, Argentina
| | - Andrea Gómez Raccio
- Servicio de Inmunología, Hospital de Niños "Dr. Ricardo Gutiérrez,", Buenos Aires, Argentina
| | - Daniela Di Giovanni
- Servicio de Inmunología, Hospital de Niños "Dr. Ricardo Gutiérrez,", Buenos Aires, Argentina
| | - María Isabel Gaillard
- Servicio Inmunología, Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP- CONICET-GCBA)- Hospital de Niños "Dr. Ricardo Gutiérrez,", Buenos Aires, Argentina.,Sección Citometría - Laboratorio Stamboulian, Buenos Aires, Argentina
| | - María Victoria Preciado
- Laboratorio de Biología Molecular, División Patología, Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), CONICET-GCBA, Hospital de Niños "Dr. Ricardo Gutiérrez,", Buenos Aires, Argentina
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10
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Shi Y, Qiao Z, Bi X, Zhang C, Fu J, Jia Y, Yang G. RF1 Gene Mutation in Familial Hemophagocytic Lymphohistiocytosis 2: A Family Report and Literature Review. Pharmgenomics Pers Med 2021; 14:1637-1645. [PMID: 34938098 PMCID: PMC8687883 DOI: 10.2147/pgpm.s326921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/24/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Gene mutation analysis was performed on a family with familial hemophagocytic lymphohistiocytosis (FHL) so as to provide an accurate etiological diagnosis, leading to genetic counseling for the family members. METHODS The clinical data of two probands (siblings) with FHL in one family were analyzed, and eight genes related to the onset of the primary hemophagocytic lymphohistiocytosis (pHLH) (PRF1, UNC13D, STX11, STXBP2, SH2D1A, BIRC4/XIAP, Rab27a, LYST) were detected and analyzed in the probands and their parents with whole exome sequencing. RESULTS Proband 1 was a two-year-old male with the clinical manifestations of fever, hepatosplenomegaly, and a decreased peripheral blood cell count, sCD25: 12504pg/mL. The results of genetic testing showed that there was a c.1349C>T heterozygous missense mutation and a c.853_855del heterozygous mutation in the PRF1 in proband 1. Proband 2 was an eight-year-old female with the clinical manifestations of convulsions and disturbance of consciousness with fever. The genetic test results were the same as those of proband 1. There was a single heterozygous mutation in the parents of the probands, and both probands had compound heterozygous mutations. CONCLUSION According to the clinical manifestations, laboratory tests, and results of the family molecular genetic testing, the probands could be clinically diagnosed as FHL2. The results of gene sequencing revealed that this was an autosomal recessive family with familial hemophagocytic syndrome. A rare pathogenic mutation (c.853_855del) in the PRF1 was discovered in the two patients with HLH.
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Affiliation(s)
- Yuan Shi
- Department of Pediatric, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, People’s Republic of China
| | - Zhidong Qiao
- Department of Pediatric, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, People’s Republic of China
| | - Xiaoduo Bi
- Department of Pediatric, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, People’s Republic of China
| | - Chenxin Zhang
- Department of Pediatric, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, People’s Republic of China
| | - Junxian Fu
- Department of Pediatric, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, People’s Republic of China
| | - Yuexin Jia
- Department of Pediatric, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, People’s Republic of China
| | - Guanglu Yang
- Department of Pediatric, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, People’s Republic of China
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