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Çelik FÇ, Soyöz Ö, Bölük SÖ, Taşkırdı İ, Hacı İA, Kaya MŞ, Demir A, Uzunoğlu B, Yıldırım AT, Onay H, Gözmen S, Gülez N, Genel F. Successful management of delayed-onset adenosine deaminase deficiency with novel mutation. Per Med 2024; 21:11-19. [PMID: 38088159 DOI: 10.2217/pme-2023-0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
A 4-year-old boy presented with acute-onset autoimmune cytopenia with severe, persistent lymphopenia, autoimmune thyroiditis, elevated IgE and glucose 6-phosphate dehydrogenase enzyme deficiency. In immunologic evaluation, lower T, B and natural killer cells and higher levels of adenosine deaminase (ADA) metabolites were observed. The compound heterozygous novel ADA gene mutations causing ADA deficiency were detected. Successful immunologic and metabolic cure was achieved with enzyme replacement therapy, followed by reduced intensity conditioning hematopoietic stem cell transplantation from a matched unrelated donor. An interesting aspect of this patient is the detection of novel compound heterozygous mutations without consanguinity and a secondary outcome is the recovery of glucose 6-phosphate dehydrogenase deficiency after hematopoietic stem cell transplantation.
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Affiliation(s)
- Figen Çelebi Çelik
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - Özgen Soyöz
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - Selime Özen Bölük
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - İlke Taşkırdı
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - İdil Akay Hacı
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - Mehmet Şirin Kaya
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - Ayça Demir
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - Berna Uzunoğlu
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - Ayşen Türedi Yıldırım
- Celal Bayar University Faculty of Medicine, Department of Pediatrics, Department of Pediatric Hematology, Manisa, Turkey
| | | | - Salih Gözmen
- Katip Celebi University Faculty of Medicine, Department of Pediatric Hematology, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital Hematopoietic Stem Cell Transplantation Unit, İzmir, Turkey
| | - Nesrin Gülez
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
| | - Ferah Genel
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behcet Uz Pediatric Diseases & Surgery Training & Research Hospital, Department of Pediatric Allergy & Immunology, Izmir, Turkey
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Sağ E, Uzunoğlu B, Bal F, Sönmez HE, Demir S, Bilginer Y, Özen S. Systemic onset juvenile idiopathic arthritis: a single center experience. Turk J Pediatr 2020; 61:852-858. [PMID: 32134578 DOI: 10.24953/turkjped.2019.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sağ E, Uzunoğlu B, Bal F, Sönmez HE, Demir S, Bilginer Y, Özen S. Systemic onset juvenile idiopathic arthritis: a single center experience. Turk J Pediatr 2019; 61: 852-858. Systemic juvenile idiopathic arthritis (sJIA) presents with prolonged fever and systemic features such as arthritis, rash, lymphadenopathy, hepatosplenomegaly and serositis. In this study, we aimed to evaluate the clinical and laboratory findings, and outcomes of sJIA patients from a tertiary rheumatology center. Between 2010-2017, patients who had been diagnosed with sJIA, participated in the study. The demographics, clinical and laboratory features, and outcomes, were evaluated retrospectively. Seventy-five sJIA (%56 male) patients were enrolled. The mean age at diagnosis was 6,45±4,80 years. At the time of diagnosis, the most common findings were fever (%100) followed by arthritis (78,7%), and rash (66,2%). Twenty-four percent of the patients present with macrophage activation syndrome (MAS) at the time of diagnosis. Totally, 36% of the patients had at least one MAS attack during the course of the disease. 46% of the patients had polyphasic course while 54% had one attack (26% monophasic, 28% persistant). All of the patients were treated with non-steroid anti-inflammatory drugs (NSAID) and/or corticosteroids at the beginning of the disease. Twenty percent of the patients reached remission with corticosteroid or disease-modifying anti-rheumatic drugs (DMARDs) however the rest of the patients needed at least one biologic agent. Anakinra was the most common first-line biologic treatment choice (n=45). Fourteen (18,7%) of the patients had polyarticular joint involvement during the disease course, and 5 of them achieved remission with tocilizumab. Systemic JIA is an important disease with high risk of morbidity and mortality. As our center is one of the most important tertiary referral rheumatology centers in the country, we had a high MAS incidence. Eighty percent of the patients achieved remission with a biological agent. Anti-IL1 drugs are mostly preferred for ongoing systemic inflammation. Anti-IL-6 agents are very efficient in patients with a polyarticular course.
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Affiliation(s)
- Erdal Sağ
- Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Berna Uzunoğlu
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fatma Bal
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hafize Emine Sönmez
- Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selcan Demir
- Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Özen
- Division of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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