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Pimpale Chavan P, Aksentijevich I, Daftary A, Panwala H, Khemani C, Khan A, Khubchandani R. Majeed Syndrome: Five Cases With Novel Mutations From Unrelated Families in India With a Review of Literature. J Rheumatol 2021; 48:1850-1855. [PMID: 33993107 DOI: 10.3899/jrheum.201663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Majeed syndrome (MJS) is an autosomal recessive, systemic autoinflammatory disease (SAID) caused by biallelic loss-of-function variants in the LPIN2 gene. It is characterized by early-onset chronic recurrent multifocal osteomyelitis (CRMO), dyserythropoietic anemia, and neutrophilic dermatosis. We analyzed a cohort of uncharacterized Indian patients for pathogenic variants in LPIN2 and other genes associated with SAIDs. METHODS We performed whole-exome sequencing (WES) for 1 patient and next-generation sequencing (NGS) targeted gene panel for SAIDs in 3 patients. One patient was a referral from neurology after clinical exome sequencing identified a novel variant in LPIN2. We reviewed the literature for all published studies of mutation-positive MJS patients and have summarized their clinical features and disease-causing variants. RESULTS We describe the largest series of patients with MJS outside of the Middle East. All 5 patients are homozygous for novel, possibly pathogenic variants in the LPIN2 gene. Two of these variants are missense substitutions, and 3 are predicted to alter transcript splicing and create a truncated protein. In addition to the classical features of CRMO and anemia, patients exhibited previously unreported features, including abdominal pain, recurrent diarrhea/ear discharge, and erythema nodosum. CONCLUSION Patients with MJS may present initially to different specialists, and thus it is important to create awareness in the medical community. In India, consanguinity is a common sociocultural factor in many ethnic communities and an abbreviated NGS gene panel for autoinflammatory diseases should include MJS. The unavailability of interleukin 1 inhibitors in some countries poses a treatment challenge.
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Affiliation(s)
- Pallavi Pimpale Chavan
- P. Pimpale Chavan, DNB Pediatrics, Fellowship in Pediatric Rheumatology, A. Khan, DCH DNB Pediatrics, R. Khubchandani, MD, Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Mumbai, India; I. Aksentijevich, MD, Genetics, Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA; A. Daftary, DABNM, DABR, Consultant Radiologist, H. Panwala, DNB Radiology, Fellowship in Pediatric Radiology, Consultant Pediatric Radiologist, NH SRCC Children's Hospital, Mumbai, India; C. Khemani, DCH DNB Pediatrics, Department of Pediatrics, North Goa District Hospital, Mapusa, Goa, India. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. R. Khubchandani, 31, Kailash Darshan, 8th floor, Opposite Ness Baug, Nana Chowk, 7, Kennedy Bridge, Gamdevi, Mumbai 400007, Maharashtra, India. . Accepted for publication April 29, 2021
| | - Ivona Aksentijevich
- P. Pimpale Chavan, DNB Pediatrics, Fellowship in Pediatric Rheumatology, A. Khan, DCH DNB Pediatrics, R. Khubchandani, MD, Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Mumbai, India; I. Aksentijevich, MD, Genetics, Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA; A. Daftary, DABNM, DABR, Consultant Radiologist, H. Panwala, DNB Radiology, Fellowship in Pediatric Radiology, Consultant Pediatric Radiologist, NH SRCC Children's Hospital, Mumbai, India; C. Khemani, DCH DNB Pediatrics, Department of Pediatrics, North Goa District Hospital, Mapusa, Goa, India. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. R. Khubchandani, 31, Kailash Darshan, 8th floor, Opposite Ness Baug, Nana Chowk, 7, Kennedy Bridge, Gamdevi, Mumbai 400007, Maharashtra, India. . Accepted for publication April 29, 2021
| | - Aditya Daftary
- P. Pimpale Chavan, DNB Pediatrics, Fellowship in Pediatric Rheumatology, A. Khan, DCH DNB Pediatrics, R. Khubchandani, MD, Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Mumbai, India; I. Aksentijevich, MD, Genetics, Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA; A. Daftary, DABNM, DABR, Consultant Radiologist, H. Panwala, DNB Radiology, Fellowship in Pediatric Radiology, Consultant Pediatric Radiologist, NH SRCC Children's Hospital, Mumbai, India; C. Khemani, DCH DNB Pediatrics, Department of Pediatrics, North Goa District Hospital, Mapusa, Goa, India. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. R. Khubchandani, 31, Kailash Darshan, 8th floor, Opposite Ness Baug, Nana Chowk, 7, Kennedy Bridge, Gamdevi, Mumbai 400007, Maharashtra, India. . Accepted for publication April 29, 2021
| | - Hiren Panwala
- P. Pimpale Chavan, DNB Pediatrics, Fellowship in Pediatric Rheumatology, A. Khan, DCH DNB Pediatrics, R. Khubchandani, MD, Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Mumbai, India; I. Aksentijevich, MD, Genetics, Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA; A. Daftary, DABNM, DABR, Consultant Radiologist, H. Panwala, DNB Radiology, Fellowship in Pediatric Radiology, Consultant Pediatric Radiologist, NH SRCC Children's Hospital, Mumbai, India; C. Khemani, DCH DNB Pediatrics, Department of Pediatrics, North Goa District Hospital, Mapusa, Goa, India. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. R. Khubchandani, 31, Kailash Darshan, 8th floor, Opposite Ness Baug, Nana Chowk, 7, Kennedy Bridge, Gamdevi, Mumbai 400007, Maharashtra, India. . Accepted for publication April 29, 2021
| | - Chetna Khemani
- P. Pimpale Chavan, DNB Pediatrics, Fellowship in Pediatric Rheumatology, A. Khan, DCH DNB Pediatrics, R. Khubchandani, MD, Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Mumbai, India; I. Aksentijevich, MD, Genetics, Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA; A. Daftary, DABNM, DABR, Consultant Radiologist, H. Panwala, DNB Radiology, Fellowship in Pediatric Radiology, Consultant Pediatric Radiologist, NH SRCC Children's Hospital, Mumbai, India; C. Khemani, DCH DNB Pediatrics, Department of Pediatrics, North Goa District Hospital, Mapusa, Goa, India. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. R. Khubchandani, 31, Kailash Darshan, 8th floor, Opposite Ness Baug, Nana Chowk, 7, Kennedy Bridge, Gamdevi, Mumbai 400007, Maharashtra, India. . Accepted for publication April 29, 2021
| | - Archana Khan
- P. Pimpale Chavan, DNB Pediatrics, Fellowship in Pediatric Rheumatology, A. Khan, DCH DNB Pediatrics, R. Khubchandani, MD, Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Mumbai, India; I. Aksentijevich, MD, Genetics, Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA; A. Daftary, DABNM, DABR, Consultant Radiologist, H. Panwala, DNB Radiology, Fellowship in Pediatric Radiology, Consultant Pediatric Radiologist, NH SRCC Children's Hospital, Mumbai, India; C. Khemani, DCH DNB Pediatrics, Department of Pediatrics, North Goa District Hospital, Mapusa, Goa, India. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. R. Khubchandani, 31, Kailash Darshan, 8th floor, Opposite Ness Baug, Nana Chowk, 7, Kennedy Bridge, Gamdevi, Mumbai 400007, Maharashtra, India. . Accepted for publication April 29, 2021
| | - Raju Khubchandani
- P. Pimpale Chavan, DNB Pediatrics, Fellowship in Pediatric Rheumatology, A. Khan, DCH DNB Pediatrics, R. Khubchandani, MD, Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Mumbai, India; I. Aksentijevich, MD, Genetics, Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA; A. Daftary, DABNM, DABR, Consultant Radiologist, H. Panwala, DNB Radiology, Fellowship in Pediatric Radiology, Consultant Pediatric Radiologist, NH SRCC Children's Hospital, Mumbai, India; C. Khemani, DCH DNB Pediatrics, Department of Pediatrics, North Goa District Hospital, Mapusa, Goa, India. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. R. Khubchandani, 31, Kailash Darshan, 8th floor, Opposite Ness Baug, Nana Chowk, 7, Kennedy Bridge, Gamdevi, Mumbai 400007, Maharashtra, India. . Accepted for publication April 29, 2021
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