1
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Fernández-Sarmiento J, Acevedo L, Niño-Serna LF, Boza R, García-Silva J, Yock-Corrales A, Yamazaki-Nakashimada MA, Faugier-Fuentes E, Del Águila O, Camacho-Moreno G, Estripeaut D, Gutiérrez IF, Luciani K, Espada G, Álvarez-Olmos MI, Pérez-Camacho P, Duarte-Passos S, Cervi MC, Cantillano EM, Llamas-Guillén BA, Saltigeral-Simental P, Criales J, Chacon-Cruz E, García-Domínguez M, Aguilar KLB, Jarovsky D, Ivankovich-Escoto G, Tremoulet AH, Ulloa-Gutierrez R. Risk Factors Associated with Intensive Care Admission in Children with Severe Acute Respiratory Syndrome Coronavirus 2-Related Multisystem Inflammatory Syndrome (MIS-C) in Latin America: A Multicenter Observational Study of the REKAMLATINA Network. J Intensive Care Med 2024:8850666241233189. [PMID: 38414438 DOI: 10.1177/08850666241233189] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Background: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 varies widely in its presentation and severity, with low mortality in high-income countries. In this study in 16 Latin American countries, we sought to characterize patients with MIS-C in the pediatric intensive care unit (PICU) compared with those hospitalized on the general wards and analyze the factors associated with severity, outcomes, and treatment received. Study Design: An observational ambispective cohort study was conducted including children 1 month to 18 years old in 84 hospitals from the REKAMLATINA network from January 2020 to June 2022. Results: A total of 1239 children with MIS-C were included. The median age was 6.5 years (IQR 2.5-10.1). Eighty-four percent (1043/1239) were previously healthy. Forty-eight percent (590/1239) were admitted to the PICU. These patients had more myocardial dysfunction (20% vs 4%; P < 0.01) with no difference in the frequency of coronary abnormalities (P = 0.77) when compared to general ward subjects. Of the children in the PICU, 83.4% (494/589) required vasoactive drugs, and 43.4% (256/589) invasive mechanical ventilation, due to respiratory failure and pneumonia (57% vs 32%; P = 0.01). On multivariate analysis, the factors associated with the need for PICU transfer were age over 6 years (aOR 1.76 95% CI 1.25-2.49), shock (aOR 7.06 95% CI 5.14-9.80), seizures (aOR 2.44 95% CI 1.14-5.36), thrombocytopenia (aOR 2.43 95% CI 1.77-3.34), elevated C-reactive protein (aOR 1.89 95% CI 1.29-2.79), and chest x-ray abnormalities (aOR 2.29 95% CI 1.67-3.13). The overall mortality was 4.8%. Conclusions: Children with MIS-C who have the highest risk of being admitted to a PICU in Latin American countries are those over age six, with shock, seizures, a more robust inflammatory response, and chest x-ray abnormalities. The mortality rate is five times greater when compared with high-income countries, despite a high proportion of patients receiving adequate treatment.
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Affiliation(s)
- Jaime Fernández-Sarmiento
- Department of Pediatrics and Intensive Care, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | - Lorena Acevedo
- Department of Pediatrics and Intensive Care, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | | | - Raquel Boza
- Unidad de Cuidados Intensivos Pediátricos, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | | | - Adriana Yock-Corrales
- Servicio de Emergencias, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | | | - Enrique Faugier-Fuentes
- Servicio de Reumatología, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Olguita Del Águila
- Unidad de Infectología Pediátrica, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - German Camacho-Moreno
- Unidad de Infectología Pediátrica, Fundación Hospital Pediátrico La Misericordia (HOMI), Bogotá, Colombia
| | - Dora Estripeaut
- Servicio de Infectología, Hospital del Niño Dr José Renán Esquivel, Ciudad de Panamá, Panamá
| | - Iván F Gutiérrez
- Servicio de Infectología, Clínica Infantil Colsubsidio, Bogotá, Colombia
| | - Kathia Luciani
- Servicio de Infectología, Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Ciudad de Panamá, Panamá
| | - Graciela Espada
- Servicio de Reumatología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | | | - Paola Pérez-Camacho
- Servicio de Infectología, Fundación Valle del Lili & Departamento de Pediatría, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Saulo Duarte-Passos
- Hospital Universitario de Faculdade de Medicina de Jundiai, Sao Paolo, Brazil
| | - Maria C Cervi
- Serviço de Infectología, Faculdade de Medicina de Ribeirāo Preto, Universidade de Sāo Paulo, Sao Paulo, Brazil
| | - Edwin M Cantillano
- Unidad de Cuidados Intensivos Pediátricos, Hospital Regional del Norte, Instituto Hondureño de Seguridad Social, San Pedro de Sula, Honduras
| | | | - Patricia Saltigeral-Simental
- Servicio de Infectología, Star Médica Hospital Infantil Privado e Instituto Nacional de Pediatría, Ciudad de México, México
| | | | - Enrique Chacon-Cruz
- Servicio de Infectología. Hospital General de Tijuana, Tijuana, México
- Think Vaccines LLC, Houston, Texas, USA
| | - Miguel García-Domínguez
- Servicio de Alergología e Inmunología, Hospital Pediátrico de Sinaloa "Dr Rigoberto Aguilar Pico," Sinaloa, México
| | - Karla L Borjas Aguilar
- Servicio de Inmunología, Hospital María, Especialidades Pediátricas e Instituto Hondureño de Seguridad Social, Hospital de Especialidades, Tegucigalpa, Honduras
| | - Daniel Jarovsky
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Gabriela Ivankovich-Escoto
- Servicio de Inmunología y Reumatología Pediátrica, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Adriana H Tremoulet
- Department of Pediatrics, University of California San Diego (UCSD) & Rady Children's Hospital, San Diego, California, USA
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera," Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
- Facultad de Medicina, Universidad de Ciencias Médicas (UCIMED), San José, Costa Rica
- Instituto de Investigación en Ciencias Médicas UCIMED (IICIMED), San José, Costa Rica
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2
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Carrillo-Tapia E, Espinosa-Padilla SE, Perez-Perez D, Gonzalez-Serrano ME, Berron-Ruiz L, Espinosa-Rosales FJ, Rodriguez-Alba JC, Mújica-Guzman F, Yokoyama-Rebollar E, García-Flores JR, Herrera-González NE, Scheffler-Mendoza S, Yamazaki-Nakashimada MA, Staines-Boone AT, Lopez-Herrera G. Improved HUMARA for the Detection of X-Linked Agammaglobulinemia Carriers. Genet Test Mol Biomarkers 2022; 26:220-227. [PMID: 35394812 DOI: 10.1089/gtmb.2021.0139] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Fragment analysis of exon 1 of the human androgen receptor, known as HUMARA, is a polymerase chain reaction (PCR)-based method for detecting X-linked agammaglobulinemia (XLA) carriers. This method takes advantage of X-chromosome inactivation (XCI) in female cells. XLA is caused by mutations in the Bruton tyrosine kinase (BTK) gene, located in Xq22.1. In this study, XCI is nonrandom or skewed in B cells. B cells with an active X-chromosome carrying a BTK mutation do not mature. Peripheral B cells in XLA carriers inactivate the mutated X-chromosome. Methods: HUMARA was performed using DNA from purified B cells and total leukocytes. DNA was digested using methylation-sensitive HhaI. The PCR of the HUMARA polymorphic marker was performed with the HhaI digested samples. The lengths of the PCR product were determined. If a suspected carrier showed skewed XCI in B cells, the marker length that corresponded with the length determined in the index patient indicated their carrier status. Results: HUMARA was conducted on purified B cells; this allowed easier identification of the mutated or inactive allele, as the active allele was enzymatically digested. Analysis of 30 possible carriers using modified HUMARA corroborated that the carrier status in all samples that were heterozygous for the marker using XCI calculation for leukocytes showed a Gaussian distribution, while the carrier B cell DNA showed a skewed XCI. Conclusion: Carrier status was successfully determined for most of the analyzed samples. B cell enrichment resulted in precise carrier determination data, reduced the sample size, and facilitated inactive and active allele identification.
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Affiliation(s)
| | - Sara E Espinosa-Padilla
- Laboratorio de Inmunodeficiencias, Instituto Nacional de Pediatría, Ciudad de México, México
| | - Daniela Perez-Perez
- Laboratorio de Inmunodeficiencias, Instituto Nacional de Pediatría, Ciudad de México, México.,Posgrado en Ciencias Biológicas, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | - Laura Berron-Ruiz
- Laboratorio de Inmunodeficiencias, Instituto Nacional de Pediatría, Ciudad de México, México
| | | | | | - Fabiola Mújica-Guzman
- Laboratorio de Hematología, Instituto Nacional de Pediatría, Ciudad de México, México
| | | | - Jose R García-Flores
- Posgrado en Ciencias de la Salud, Escuela Superior de Medicina, Ciudad de México, México
| | | | | | | | | | - Gabriela Lopez-Herrera
- Laboratorio de Inmunodeficiencias, Instituto Nacional de Pediatría, Ciudad de México, México
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3
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Rivas-Calderon M, Yamazaki-Nakashimada MA, Orozco-Covarrubias L, Durán-McKinster C, Pacheco-Tovar D, Ávalos-Díaz E, Sáez-de-Ocariz M. Bronchiolitis Obliterans With Anti-Epiplakin Antibodies in a Boy With Paraneoplastic Pemphigus. Pediatrics 2022; 149:184740. [PMID: 35118492 DOI: 10.1542/peds.2021-052132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/24/2022] Open
Abstract
Paraneoplastic pemphigus is a rare and severe autoimmune blistering disease characterized by a recalcitrant and severe mucositis, and polymorphic cutaneous lesions, associated with benign and malignant neoplasms. Paraneoplastic pemphigus is caused by production of autoantibodies against various epidermal proteins involved in cell adhesion. Bronchiolitis obliterans (BO) is one of the leading causes of mortality in these patients. Recent advances have associated the presence of anti-epiplakin antibodies with the development of BO in adult patients. Here we describe the first pediatric patient in whom the association of anti-epiplakin antibodies and BO have been reported so far.
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Affiliation(s)
| | | | | | | | - Deyanira Pacheco-Tovar
- Department of Immunology, Unidad Académica de Ciencias Biológicas, Universidad Autónoma de Zacatecas, Mexico
| | - Esperanza Ávalos-Díaz
- Department of Immunology, Unidad Académica de Ciencias Biológicas, Universidad Autónoma de Zacatecas, Mexico
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4
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Olguin-Calderón D, Velásquez-Ortiz MG, Huerta-Robles HMR, López-Herrera G, Segura-Méndez NH, O'Farrill-Romanillos P, Scheffler-Mendoza S, Yamazaki-Nakashimada MA, García-Cruz ML, Espinosa-Padilla SE, Staines-Boone TA, Santos-Argumedo L, Berrón-Ruiz L. Atypical patterns of STAT3 phosphorylation in subpopulations B cells in patients with common variable immunodeficiency. Hum Immunol 2022; 83:428-436. [PMID: 35177260 DOI: 10.1016/j.humimm.2022.01.013] [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] [Received: 06/23/2021] [Revised: 01/09/2022] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Common Variable Immunodeficiency (CVID) is a heterogeneous disorder characterized by defective B cell differentiation and antibody production. Interleukin (IL)-21 activates STAT3, a potent regulator of B cell differentiation into plasma cells. We have studied the phosphorylation of STAT3 in CVID patients and its contribution to B cells subsets. METHODS We studied 23 CVID patients and 14 healthy donors (HD), determining pSTAT3 in naïve and memory B cells, stimulated with IL-21 at 15 and 60 min. RESULTS pSTAT3 was increased in total (p = 0.044), naïve (p = 0.023), and memory (p = 0.001) B cells at 60 min in CVID patients compared with HD. We classified patients by the percentage of isotype-switched memory B cells. We observed an increase in pSTAT3 at 60 min in memory B cells in both CVID groups of patients (p = 0.026, p = 0.007, respectively). Interestingly, the analysis of each group individually; demonstrated that patients with decreased memory B cells exhibited an increase in pSTAT3 at 60 min (p = 0.023), while HD had an expected decrease in pSTAT3 (p = 0.045). CONCLUSION CVID patients showed an increased atypical of pSTAT3, which could affect the differentiation of B cells. Further studies in the IL-21 pathway are necessary to understand how this alteration could promote differentiation defects in patient B cells.
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Affiliation(s)
| | | | - H M Raquel Huerta-Robles
- Laboratorio de Inmunodeficiencias, Instituto Nacional de Pediatría SSA, Ciudad de México, Mexico
| | - Gabriela López-Herrera
- Laboratorio de Inmunodeficiencias, Instituto Nacional de Pediatría SSA, Ciudad de México, Mexico
| | - Nora H Segura-Méndez
- Servicio de Alergia e Inmunología Clínica, Hospital de Especialidades del Centro Médico Siglo XXI, IMSS, Mexico
| | | | - Selma Scheffler-Mendoza
- Servicio de Inmunología y Alergia, Instituto Nacional de Pediatría SSA, Ciudad de México, Mexico
| | | | | | - Sara E Espinosa-Padilla
- Laboratorio de Inmunodeficiencias, Instituto Nacional de Pediatría SSA, Ciudad de México, Mexico
| | - Tamara A Staines-Boone
- Servicio de Alta Especialidad, Centro Médico Noreste IMSS, Monterrey, Nuevo León, Mexico
| | | | - Laura Berrón-Ruiz
- Laboratorio de Inmunodeficiencias, Instituto Nacional de Pediatría SSA, Ciudad de México, Mexico.
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5
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Blancas-Galicia L, Peñafiel-Vicuña AK, Scheffler-Mendoza S, Rojas-Maruri M, Rivas-Larrauri F, Rodríguez-Lozano AL, Bustamante J, Yamazaki-Nakashimada MA. Recurrent Salmonella Infections and Nephritis Complicating IgA Vasculitis in a Patient with IL12-RB1 Deficiency. J Investig Allergol Clin Immunol 2021; 32:308-310. [PMID: 34489232 DOI: 10.18176/jiaci.0750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- L Blancas-Galicia
- Immunodeficiencies Research Unit, National Institute of Pediatrics, Mexico, Mexico City
| | - A K Peñafiel-Vicuña
- Immunodeficiencies Research Unit, National Institute of Pediatrics, Mexico, Mexico City.,Clinical Immunology Department, National Institute of Pediatrics, Mexico, Mexico City
| | - S Scheffler-Mendoza
- Clinical Immunology Department, National Institute of Pediatrics, Mexico, Mexico City
| | - M Rojas-Maruri
- Pathology Department, National Institute of Pediatrics, Mexico, Mexico City
| | - F Rivas-Larrauri
- Clinical Immunology Department, National Institute of Pediatrics, Mexico, Mexico City
| | - A L Rodríguez-Lozano
- Clinical Immunology Department, National Institute of Pediatrics, Mexico, Mexico City
| | - J Bustamante
- St. Giles Laboratory of Human Genetics of Infectious Disease, Rockefeller Branch, Rockefeller University, New York, NK, United States.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Paris, France.,Imagine Institute, University of Paris, Paris, France.,Study Center for Immunodeficiencies, Necker Hospital for Sick Children, AP-HP, Paris, France
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6
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Palacios-Reyes D, Yamazaki-Nakashimada MA, Castaño-Jaramillo L, Roman-Montes CM, González-Lara MF, Scheffler-Mendoza S, Costta-Michuy A, Bustamante J, Blancas-Galicia L. Pulmonary Geotrichosis in Chronic Granulomatous Disease. J Investig Allergol Clin Immunol 2021; 32:306-308. [PMID: 34489233 DOI: 10.18176/jiaci.0749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- D Palacios-Reyes
- Mycology Department, National Institute of Pediatrics, Mexico City, Mexico
| | | | - L Castaño-Jaramillo
- Immunology Department, National Institute of Pediatrics, Mexico City, Mexico
| | - C M Roman-Montes
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - M F González-Lara
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - S Scheffler-Mendoza
- Immunology Department, National Institute of Pediatrics, Mexico City, Mexico
| | - A Costta-Michuy
- Infectious Diseases Department, National Institute of Pediatrics, Mexico City, Mexico
| | - J Bustamante
- St. Giles Laboratory of Human Genetics of Infectious Disease, Rockefeller Branch, Rockefeller University, New York, NK, United States.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Paris, France.,Imagine Institute, University of Paris, Paris, France.,Study Center for Immunodeficiencies, Necker Hospital for Sick Children, AP-HP, Paris, France
| | - L Blancas-Galicia
- Immunodeficiencies Research Unit, National Institute of Pediatrics, Mexico City, Mexico
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7
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Gámez-González LB, Ulloa-Gutierrez R, Murata C, Yamazaki-Nakashimada MA, Kim E, Estripeaut D, Del Águila O, Garrido-García LM, Gómez V, Faugier-Fuentes E, Miño G, Beltrán S, Cofré F, Chacón-Cruz E, Saltigeral-Simental P, Martínez-Medina L, Tremoulet AH, Astigarraga N. Kawasaki disease presenting with hoarseness: A multinational study of the REKAMLATINA network. Pediatr Int 2021; 63:643-648. [PMID: 33099854 DOI: 10.1111/ped.14521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/30/2020] [Accepted: 09/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently, hoarseness affecting the supraglottic structure has been reported in Kawasaki disease (KD). The objective of this study was to characterize the frequency of hoarseness in acute KD patients in Latin America. METHODS We used prospective data from the multinational Red de Enfermedad de Kawasaki en America Latina (REKAMLATINA) network. A total of 865 patients from 20 countries were enrolled during the 3 year study period. Data on hoarseness were available in 858 (99.2%) patients. The clinical and laboratory characteristics between hoarse and non-hoarse KD were compared. RESULTS Hoarseness was documented in 100 (11.6%) patients. Hoarse patients were younger than those with KD without hoarseness (median age 18 vs 26 months; P = 0.002) and presented with lower hemoglobin (10.7 g/dL vs 11.3 g/dL; P = 0.040) and hematocrit levels (32% vs 33%, P = 0.048). CONCLUSIONS Hoarseness was found to be prevalent as a presenting sign of acute KD in younger children. Anemia may indicate the presence of active inflammation.
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Affiliation(s)
- Luisa B Gámez-González
- Servicio Inmunología y Alergia, Hospital Infantil Especialidades de Chihuahua, Chihuahua, México
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños "Dr Carlos Sáenz Herrera", Centro de Ciencias Médicas, Caja Costarricense de Seguro Social (CCSS), San José, Costa Rica
| | - Chiharu Murata
- Research Methodology Department, Instituto Nacional Pediatría, Mexico City, Mexico
| | | | - Elissa Kim
- Department of Pediatrics, University of California San Diego & Rady Children's Hospital, San Diego, CA, USA
| | - Dora Estripeaut
- Servicio de Infectología, Hospital del Niño, Ciudad Panamá, Panamá
| | - Olguita Del Águila
- Unidad de Infectología Pediátrica del Hospital Nacional Edgardo Rebagliati Martins-Lima-Perú, Lince, Perú
| | | | - Virgen Gómez
- Servicio de Infectología, Centro Médico, Universidad Central del Este Hospital y Hospital Infantil "Dr Robert Reid Cabral", Santo Domingo, República Dominicana
| | | | - Greta Miño
- Servicio de Infectología, Hospital del Niño "Francisco de Ycaza Bustamante", Guayaquil, Ecuador
| | - Sandra Beltrán
- Servicio de Infectología, Clínica Colsanitas, Bogotá, Colombia
| | - Fernanda Cofré
- Servicio de Infectología, Hospital Roberto del Río, Santiago, Chile
| | | | | | | | - Adriana H Tremoulet
- Department of Pediatrics, University of California San Diego & Rady Children's Hospital, San Diego, CA, USA
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8
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Castaño-Jaramillo LM, Lugo-Reyes SO, Cruz Muñoz ME, Scheffler-Mendoza SC, Duran McKinster C, Yamazaki-Nakashimada MA, Espinosa-Padilla SE, Saez-de-Ocariz Gutierrez MDM. Diagnostic and therapeutic caveats in Griscelli syndrome. Scand J Immunol 2021; 93:e13034. [PMID: 33660295 DOI: 10.1111/sji.13034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/26/2021] [Indexed: 12/23/2022]
Abstract
Griscelli syndrome (GS) is a rare autosomal recessive disease with characteristic pigment distribution, and there are currently 3 types according to the underlying genetic defect and clinical features. We present the case of a girl born from consanguineous parents who presented with predominant neurologic symptoms, silvery hair and granulomatous skin lesions. Cerebral magnetic resonance revealed diffuse white matter lesions, and central nervous system (CNS) lymphocytic infiltration was suspected. The patient underwent haematopoietic stem cell transplantation with graft failure and autologous reconstitution. She developed elevated liver enzyme with a cholestatic pattern. Multiple liver biopsies revealed centrilobular cholestasis and unspecific portal inflammation that improved with immunomodulatory treatment. She was revealed to have an impaired cytotoxicity in NK cells and a decreased expression of RAB27A. However, no variants were found in the gene. All types of GS present with pigment dilution and irregular pigment clumps that can be seen through light microscopy in hair and skin biopsy. Dermic granulomas and immunodeficiency with infectious and HLH predisposition have been described in GS type 2 (GS2). Neurologic alterations might be seen in GS type 1 (GS1) and GS type 2 (GS2), due to different mechanisms. GS1 presents with neurologic impairment secondary to myosin Va role in neuronal development and synapsis. Meanwhile, GS2 can present with neurologic impairment secondary to SNC HLH. Clinical features and cytotoxicity might aid in differentiating GS1 and GS2, especially since treatment differs.
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Affiliation(s)
| | - Saul O Lugo-Reyes
- Immunodeficiencies Research Unit, Instituto Nacional de Pediatria, Mexico City, Mexico
| | - Mario E Cruz Muñoz
- Molecular Immunology Laboratory. Faculty of Medicine, Universidad Autonoma del Estado de Morelos, Cuernavaca, Mexico
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9
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Ulloa-Gutiérrez R, Ivankovich-Escoto G, Yamazaki-Nakashimada MA. Multisystem inflammatory syndrome associated with COVID19 in children and adolescents: calling for diagnosis. Rev Chilena Infectol 2020; 37:199-201. [PMID: 32853309 DOI: 10.4067/s0716-10182020000300199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Rolando Ulloa-Gutiérrez
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas de la Caja Costarricense de Seguro Social, San José, Costa Rica
| | - Gabriela Ivankovich-Escoto
- Servicio de Inmunología y Reumatología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas de la Caja Costarricense de Seguro Social, San José, Costa Rica
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10
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Yamazaki-Nakashimada MA, Roldán-Marín R, Toussaint-Caire S, Olaya-Vargas A, Ramírez-Uribe N, Rivas-Larrauri F, Durán-McKinster C, Alcántara-Ortigoza MA, González-Del Angel A, Orozco-Covarrubias L, Scheffler-Mendoza S, Saez-de-Ocariz M. Hair pigment distribution changes after haematopoietic stem cell transplantation in Griscelli syndrome type 2. J Eur Acad Dermatol Venereol 2020; 35:e53-e56. [PMID: 32594618 DOI: 10.1111/jdv.16795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - R Roldán-Marín
- Dermato-Oncology Clinic, Faculty of Medicine at the Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - S Toussaint-Caire
- Dermatopathology Department, Dermatology Division at the Hospital General 'Dr. Manuel Gea González', Mexico City, Mexico
| | - A Olaya-Vargas
- Transplant Department, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - N Ramírez-Uribe
- Transplant Department, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - F Rivas-Larrauri
- Immunology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - C Durán-McKinster
- Dermatology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - M A Alcántara-Ortigoza
- Molecular Biology Laboratory at the Instituto Nacional de Pediatría, Mexico City, Mexico
| | - A González-Del Angel
- Molecular Biology Laboratory at the Instituto Nacional de Pediatría, Mexico City, Mexico
| | | | | | - M Saez-de-Ocariz
- Dermatology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
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11
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Yamazaki-Nakashimada MA, Santos-Chávez EE, de Jesus AA, Rivas-Larrauri F, Guzmán-Martínez MN, Goldbach-Mansky R, Espinosa-Padilla S, Sáez-de-Ocariz MDM, Orozco-Covarrubias L, Blancas-Galicia L. Systemic Autoimmunity in a Patient With CANDLE Syndrome. J Investig Allergol Clin Immunol 2019; 29:75-76. [PMID: 30785112 DOI: 10.18176/jiaci.0338] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - E E Santos-Chávez
- Immunodeficiencies Research Unit, National Institute of Pediatrics, Mexico City, Mexico
| | - A A de Jesus
- Translational Autoinflammatory Disease Section (TADS), Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - F Rivas-Larrauri
- Clinical Immunology Department, National Institute of Pediatrics, Mexico City, Mexico
| | - M N Guzmán-Martínez
- Immunodeficiencies Research Unit, National Institute of Pediatrics, Mexico City, Mexico
| | - R Goldbach-Mansky
- Translational Autoinflammatory Disease Section (TADS), Laboratory of Clinical Immunology and Microbiology (LCIM), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - S Espinosa-Padilla
- Immunodeficiencies Research Unit, National Institute of Pediatrics, Mexico City, Mexico
| | - M dM Sáez-de-Ocariz
- Dermatology Department, National Institute of Pediatrics, Mexico City, Mexico
| | | | - L Blancas-Galicia
- Immunodeficiencies Research Unit, National Institute of Pediatrics, Mexico City, Mexico
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12
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López-Hernández I, Guzmán-Martínez MN, Medina-Vera I, Yamazaki-Nakashimada MA, Saracho-Weber F, Gámez-González LB, Saez-de-Ocariz M, Espinosa-Padilla SE, Blancas-Galicia L. Clinical Manifestations in Carriers of X-Linked Chronic Granulomatous Disease in Mexico. J Investig Allergol Clin Immunol 2019; 29:134-136. [PMID: 31017111 DOI: 10.18176/jiaci.0343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- I López-Hernández
- Immunodeficiencies Research Unit, National Pediatrics Institute, Mexico City, Mexico
| | - M N Guzmán-Martínez
- Immunodeficiencies Research Unit, National Pediatrics Institute, Mexico City, Mexico
| | - I Medina-Vera
- Department of Research Methodology, National Pediatrics Institute, Mexico City, Mexico
| | | | - F Saracho-Weber
- Clinical Immunology Department, Chihuahua Children Hospital, Chihuahua, Mexico
| | - L B Gámez-González
- Clinical Immunology Department, Chihuahua Children Hospital, Chihuahua, Mexico
| | - M Saez-de-Ocariz
- Department of Dermatology, National Pediatrics Institute, Mexico City, Mexico
| | - S E Espinosa-Padilla
- Immunodeficiencies Research Unit, National Pediatrics Institute, Mexico City, Mexico
| | - L Blancas-Galicia
- Immunodeficiencies Research Unit, National Pediatrics Institute, Mexico City, Mexico
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13
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Morán-Villaseñor E, Saez-de-Ocariz M, Torrelo A, Arostegui JI, Yamazaki-Nakashimada MA, Alcántara-Ortigoza MA, González-Del-Angel A, Velázquez-Aragón JA, López-Herrera G, Berrón-Ruiz L, García-Romero MT. Expanding the clinical features of autoinflammation and phospholipase Cγ2-associated antibody deficiency and immune dysregulation by description of a novel patient. J Eur Acad Dermatol Venereol 2019; 33:2334-2339. [PMID: 31465591 DOI: 10.1111/jdv.15918] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/21/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Autoinflammation and phospholipase Cγ2-associated antibody deficiency and immune dysregulation (APLAID) is an exceedingly rare monogenic autoinflammatory disease. To date, only five cases have been reported with four distinct pathogenic mutations. OBJECTIVES We present a novel case of APLAID, corroborated by molecular analysis, with newly described clinical findings including central nervous system vasculitis (CNSV); and distinctive histopathological characteristics that may expand our knowledge of this rare disease's phenotype. METHODS This is a case report presentation of a 3-year-old boy, seen at a reference paediatric hospital in Mexico. His parents authorized the use of his clinical information and photographs. RESULTS A 3-day-old boy presented to the emergency department with a vesiculo-pustular rash that resolved within 1 week. Two months later, he developed widespread papules and pseudovesicles that evolved into infiltrated plaques. He also had periodical flares of conjunctivitis, diarrhoea and erythematous blistering acral plaques triggered by upper respiratory infections. By the age of 10 months, he experienced seizures and CNSV. Laboratory work-up showed mild neutropenia, decreased serum levels of immunoglobulins and B-cell lymphopenia. A skin biopsy revealed a dense, perivascular and interstitial histiocytic and granulomatous infiltrate, with palisading granulomas, and leucocytoclastic vasculitis with karyorrhexis. APLAID syndrome was confirmed by Sanger sequencing of PLCG2 gene [heterozygous genotype LRG_376t1:c.2543T>C or p.(Leu848Pro)]. CONCLUSIONS Presence of CNSV has not been previously described in APLAID, however as the number of reported patients with APLAID is very small, it is possible that the overall spectrum of clinical manifestations has not been completely elucidated. The herein identified p.(Leu848Pro) variant was also documented in a Portuguese patient, suggesting that it could be a PLCG2 gene 'hot-spot'.
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Affiliation(s)
- E Morán-Villaseñor
- Department of Dermatology, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - M Saez-de-Ocariz
- Department of Dermatology, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - A Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - J I Arostegui
- Department of Immunology, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | | | - A González-Del-Angel
- Laboratory of Molecular Biology, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - J A Velázquez-Aragón
- Laboratory of Molecular Biology, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - G López-Herrera
- Immunodeficiencies Research Unit, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - L Berrón-Ruiz
- Immunodeficiencies Research Unit, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - M T García-Romero
- Department of Dermatology, Instituto Nacional de Pediatría, Mexico City, Mexico
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14
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Rosain J, Oleaga-Quintas C, Deswarte C, Verdin H, Marot S, Syridou G, Mansouri M, Mahdaviani SA, Venegas-Montoya E, Tsolia M, Mesdaghi M, Chernyshova L, Stepanovskiy Y, Parvaneh N, Mansouri D, Pedraza-Sánchez S, Bondarenko A, Espinosa-Padilla SE, Yamazaki-Nakashimada MA, Nieto-Patlán A, Kerner G, Lambert N, Jacques C, Corvilain E, Migaud M, Grandin V, Herrera MT, Jabot-Hanin F, Boisson-Dupuis S, Picard C, Nitschke P, Puel A, Tores F, Abel L, Blancas-Galicia L, De Baere E, Bole-Feysot C, Casanova JL, Bustamante J. A Variety of Alu-Mediated Copy Number Variations Can Underlie IL-12Rβ1 Deficiency. J Clin Immunol 2018; 38:617-627. [PMID: 29995221 DOI: 10.1007/s10875-018-0527-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Inborn errors of IFN-γ immunity underlie Mendelian susceptibility to mycobacterial disease (MSMD). Autosomal recessive complete IL-12Rβ1 deficiency is the most frequent genetic etiology of MSMD. Only two of the 84 known mutations are copy number variations (CNVs), identified in two of the 213 IL-12Rβ1-deficient patients and two of the 164 kindreds reported. These two CNVs are large deletions found in the heterozygous or homozygous state. We searched for novel families with IL-12Rβ1 deficiency due to CNVs. METHODS We studied six MSMD patients from five unrelated kindreds displaying adverse reactions to BCG vaccination. Three of the patients also presented systemic salmonellosis, two had mucocutaneous candidiasis, and one had disseminated histoplasmosis. We searched for CNVs and other variations by IL12RB1-targeted next-generation sequencing (NGS). RESULTS We identified six new IL-12Rβ1-deficient patients with a complete loss of IL-12Rβ1 expression on phytohemagglutinin-activated T cells and/or EBV-transformed B cells. The cells of these patients did not respond to IL-12 and IL-23. Five different CNVs encompassing IL12RB1 (four deletions and one duplication) were identified in these patients by NGS coverage analysis, either in the homozygous state (n = 1) or in trans (n = 4) with a single-nucleotide variation (n = 3) or a small indel (n = 1). Seven of the nine mutations are novel. Interestingly, four of the five CNVs were predicted to be driven by nearby Alu elements, as well as the two previously reported large deletions. The IL12RB1 locus is actually enriched in Alu elements (44.7%), when compared with the rest of the genome (10.5%). CONCLUSION The IL12RB1 locus is Alu-enriched and therefore prone to rearrangements at various positions. CNVs should be considered in the genetic diagnosis of IL-12Rβ1 deficiency.
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Affiliation(s)
- Jérémie Rosain
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Necker Hospital for Sick Children, Paris, France.,Imagine Institute, Paris Descartes University, Paris, France.,Study Center for Primary Immunodeficiencies, AP-HP, Necker Hospital for Sick Children, Paris, France
| | - Carmen Oleaga-Quintas
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Necker Hospital for Sick Children, Paris, France.,Imagine Institute, Paris Descartes University, Paris, France
| | - Caroline Deswarte
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Necker Hospital for Sick Children, Paris, France.,Imagine Institute, Paris Descartes University, Paris, France
| | - Hannah Verdin
- Center for Medical Genetics, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Stéphane Marot
- Study Center for Primary Immunodeficiencies, AP-HP, Necker Hospital for Sick Children, Paris, France
| | | | - Mahboubeh Mansouri
- Department of Allergy and Clinical Immunology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Alireza Mahdaviani
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Edna Venegas-Montoya
- The Immunodeficiencies Research Unit, National Institute of Pediatrics, Mexico City, Mexico
| | - Maria Tsolia
- Second Department of Pediatrics, P. and A. Kyriakou Children's Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Mehrnaz Mesdaghi
- Department of Allergy and Clinical Immunology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Liudmyla Chernyshova
- Department of Pediatric Infectious Diseases and Immunology, Shupyk National Medical Academy for Postgraduate Education, Kiev, Ukraine
| | - Yuriy Stepanovskiy
- Department of Pediatric Infectious Diseases and Immunology, Shupyk National Medical Academy for Postgraduate Education, Kiev, Ukraine
| | - Nima Parvaneh
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Davood Mansouri
- Department of Internal Medicine, Division of Infectious Disease and Clinical Immunology, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sigifredo Pedraza-Sánchez
- Unit of Biochemistry, National Institute for Medical Sciences and Nutrition Salvador Zubiran (INCMNSZ), Mexico City, Mexico
| | - Anastasia Bondarenko
- Department of Pediatric Infectious Diseases and Immunology, Shupyk National Medical Academy for Postgraduate Education, Kiev, Ukraine
| | | | | | - Alejandro Nieto-Patlán
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Necker Hospital for Sick Children, Paris, France.,Imagine Institute, Paris Descartes University, Paris, France
| | - Gaspard Kerner
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Necker Hospital for Sick Children, Paris, France.,Imagine Institute, Paris Descartes University, Paris, France
| | - Nathalie Lambert
- Study Center for Primary Immunodeficiencies, AP-HP, Necker Hospital for Sick Children, Paris, France
| | - Corinne Jacques
- Study Center for Primary Immunodeficiencies, AP-HP, Necker Hospital for Sick Children, Paris, France
| | - Emilie Corvilain
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Necker Hospital for Sick Children, Paris, France.,Imagine Institute, Paris Descartes University, Paris, France.,Free University of Brussels, Brussels, Belgium
| | - Mélanie Migaud
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Necker Hospital for Sick Children, Paris, France.,Imagine Institute, Paris Descartes University, Paris, France
| | - Virginie Grandin
- Study Center for Primary Immunodeficiencies, AP-HP, Necker Hospital for Sick Children, Paris, France
| | - María T Herrera
- Department of Microbiology Research, National Institute of Respiratory Diseases (INER), Mexico City, Mexico
| | - Fabienne Jabot-Hanin
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Necker Hospital for Sick Children, Paris, France.,Imagine Institute, Paris Descartes University, Paris, France
| | - Stéphanie Boisson-Dupuis
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Necker Hospital for Sick Children, Paris, France.,Imagine Institute, Paris Descartes University, Paris, France.,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, USA
| | - Capucine Picard
- Imagine Institute, Paris Descartes University, Paris, France.,Study Center for Primary Immunodeficiencies, AP-HP, Necker Hospital for Sick Children, Paris, France.,Pediatric Hematology-Immunology Unit, AP-HP, Necker Hospital for Sick Children, Paris, France
| | - Patrick Nitschke
- Bioinformatics Core Facility, Imagine Institute, SFR-Necker, INSERM UMR1163 and INSERM US24/CNRS UMS3633, Paris Descartes Sorbonne Paris Cite University, Paris, France
| | - Anne Puel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Necker Hospital for Sick Children, Paris, France.,Imagine Institute, Paris Descartes University, Paris, France.,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, USA
| | - Frederic Tores
- Bioinformatics Core Facility, Imagine Institute, SFR-Necker, INSERM UMR1163 and INSERM US24/CNRS UMS3633, Paris Descartes Sorbonne Paris Cite University, Paris, France
| | - Laurent Abel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Necker Hospital for Sick Children, Paris, France.,Imagine Institute, Paris Descartes University, Paris, France.,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, USA
| | | | - Elfride De Baere
- Center for Medical Genetics, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Christine Bole-Feysot
- Genomic Core Facility, INSERM UMR1163, SFR-Necker, Imagine Institute, Paris, France.,INSERM US24/CNRS UMS3633, Paris Descartes Sorbonne Paris Cite University, Paris, France
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Necker Hospital for Sick Children, Paris, France.,Imagine Institute, Paris Descartes University, Paris, France.,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, USA.,Pediatric Hematology-Immunology Unit, AP-HP, Necker Hospital for Sick Children, Paris, France.,Howard Hughes Medical Institute, New York, NY, USA
| | - Jacinta Bustamante
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR1163, Necker Hospital for Sick Children, Paris, France. .,Imagine Institute, Paris Descartes University, Paris, France. .,Study Center for Primary Immunodeficiencies, AP-HP, Necker Hospital for Sick Children, Paris, France. .,St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, USA.
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15
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Staines Boone AT, Chinn IK, Alaez-Versón C, Yamazaki-Nakashimada MA, Carrillo-Sánchez K, García-Cruz MDLLH, Poli MC, González Serrano ME, Medina Torres EA, Muzquiz Zermeño D, Forbes LR, Espinosa-Rosales FJ, Espinosa-Padilla SE, Orange JS, Lugo Reyes SO. Failing to Make Ends Meet: The Broad Clinical Spectrum of DNA Ligase IV Deficiency. Case Series and Review of the Literature. Front Pediatr 2018; 6:426. [PMID: 30719430 PMCID: PMC6348249 DOI: 10.3389/fped.2018.00426] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/21/2018] [Indexed: 12/31/2022] Open
Abstract
DNA repair defects are inborn errors of immunity that result in increased apoptosis and oncogenesis. DNA Ligase 4-deficient patients suffer from a wide range of clinical manifestations since early in life, including: microcephaly, dysmorphic facial features, growth failure, developmental delay, mental retardation; hip dysplasia, and other skeletal malformations; as well as a severe combined immunodeficiency, radiosensitivity, and progressive bone marrow failure; or, they may present later in life with hematological neoplasias that respond catastrophically to chemo- and radiotherapy; or, they could be asymptomatic. We describe the clinical, laboratory, and genetic features of five Mexican patients with LIG4 deficiency, together with a review of 36 other patients available in PubMed Medline. Four out of five of our patients are dead from lymphoma or bone marrow failure, with severe infection and massive bleeding; the fifth patient is asymptomatic despite a persistent CD4+ lymphopenia. Most patients reported in the literature are microcephalic females with growth failure, sinopulmonary infections, hypogammaglobulinemia, very low B-cells, and radiosensitivity; while bone marrow failure and malignancy may develop at a later age. Dysmorphic facial features, congenital hip dysplasia, chronic liver disease, gradual pancytopenia, lymphoma or leukemia, thrombocytopenia, and gastrointestinal bleeding have been reported as well. Most mutations are compound heterozygous, and all of them are hypomorphic, with two common truncating mutations accounting for the majority of patients. Stem-cell transplantation after reduced intensity conditioning regimes may be curative.
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Affiliation(s)
| | - Ivan K Chinn
- Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, United States.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Carmen Alaez-Versón
- Genomic Diagnostic Laboratory at the National Institute for Genomic Medicine (INMEGEN), Mexico City, Mexico
| | | | - Karol Carrillo-Sánchez
- Genomic Diagnostic Laboratory at the National Institute for Genomic Medicine (INMEGEN), Mexico City, Mexico
| | | | - M Cecilia Poli
- Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, United States.,Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago de Chile, Chile
| | - M Edith González Serrano
- Immunodeficiencies Research Unit at the National Institute of Pediatrics (INP), Mexico City, Mexico
| | - Edgar A Medina Torres
- Immunodeficiencies Research Unit at the National Institute of Pediatrics (INP), Mexico City, Mexico
| | - David Muzquiz Zermeño
- Immunology Department at Hospital de Especialidades, UMAE 25 IMSS, Monterrey, Mexico
| | - Lisa R Forbes
- Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, United States.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Francisco J Espinosa-Rosales
- Immunodeficiencies Research Unit at the National Institute of Pediatrics (INP), Mexico City, Mexico.,Mexican Foundation for Girls and Boys with Primary Immunodeficiencies (FUMENI, AC), Huixquilucan, Mexico
| | - Sara E Espinosa-Padilla
- Immunodeficiencies Research Unit at the National Institute of Pediatrics (INP), Mexico City, Mexico
| | - Jordan S Orange
- Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, United States.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Saul Oswaldo Lugo Reyes
- Immunodeficiencies Research Unit at the National Institute of Pediatrics (INP), Mexico City, Mexico
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16
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Yamazaki-Nakashimada MA, Saez-de-Ocariz M, Maldonado-Colin G, García-Romero MT. Subcutaneous immunoglobulin for the treatment of deep morphoea in a child. Clin Exp Dermatol 2017; 43:303-305. [PMID: 29280519 DOI: 10.1111/ced.13352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2017] [Indexed: 11/30/2022]
Abstract
Morphoea, also known as localized scleroderma, is a disorder characterized by excessive collagen deposition leading to thickening of the dermis and/or subcutaneous tissues. Intravenous IgG therapy has induced improvement in some fibrotic conditions. The primary indication for subcutaneous IgG (SCIG) is in primary immunodeficiency disorders as replacement therapy; however, recently there has been considerable interest in SCIG as an immunomodulatory agent. We report an 11-year-old girl with deep morphoea who was successfully treated with SCIG.
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Affiliation(s)
| | - M Saez-de-Ocariz
- Department of Dermatology, Instituto Nacional Pediatría, Mexico City, Mexico
| | - G Maldonado-Colin
- Department of Dermatology, Instituto Nacional Pediatría, Mexico City, Mexico
| | - M T García-Romero
- Department of Dermatology, Instituto Nacional Pediatría, Mexico City, Mexico
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17
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García-Pavón S, Yamazaki-Nakashimada MA, Báez M, Borjas-Aguilar KL, Murata C. Kawasaki Disease Complicated With Macrophage Activation Syndrome: A Systematic Review. J Pediatr Hematol Oncol 2017; 39:445-451. [PMID: 28562511 DOI: 10.1097/mph.0000000000000872] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Macrophage activation syndrome (MAS), also known as secondary hemophagocytic lymphohistiocytosis, is a rare and potentially fatal complication of Kawasaki disease (KD). We report 2 cases, performed a literature search, and analyze the characteristics of MAS associated with KD. A total of 69 patients were evaluated, 34 reported the date of the diagnosis of MAS and KD, 6% had a diagnosis of MAS before KD, 21% had a simultaneous presentation, and 73% had the diagnosis of MAS after KD. Different treatment approaches were observed with corticosteroids administered in 87%, cyclosporine in 49%, etoposide (VP-16) in 39%, and monoclonal anti-TNF in 6% of cases. Coronary abnormalities were especially high in this group of patients (46%) and 9 patients died (13%). The persistence of fever with splenomegaly, hyperferritinemia, thrombocytopenia, and elevated aspartate aminotransferase (AST) should prompt the consideration of MAS complicating KD.
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Affiliation(s)
- Susana García-Pavón
- *Allergy and Immunology Department, Naval Hospital of High Speciality †Clinical Immunology Department, National Institute of Pediatrics ‡Pediatric Private Practice §Research Methodology Department, National Institute of Pediatrics
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18
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Muriel-Vizcaíno R, Treviño-Garza G, Murata C, Staines-Boone AT, Yamazaki-Nakashimada MA, Espinosa-Padilla SE, Espinosa-Rosales FJ. Respuesta a la carta al Editor. Acta Pediatr Mex 2017. [DOI: 10.18233/apm38no2pp136-1381367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Le agradecemos por darnos la oportunidad de contestar a la carta “Magnitud del tamaño del efecto y su importancia en la investigación pediátrica”1 del Dr. Tomás Caycho. También quisiéramos agradecer por las observaciones y comentarios del Dr. Caycho, a través de los cuales se señala la importancia y necesidad de reportar tamaño de efecto en los resultados de análisis estadístico en las investigaciones y de nuestro trabajo: “Calidad de vida de los pacientes con inmunodeficiencias primarias de anticuerpos”2 publicado en esta revista.
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19
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Rodríguez-González M, Gámez-González LB, Garrido-García M, Yamazaki-Nakashimada MA. Kawasaki disease after all. Semin Arthritis Rheum 2016; 45:e24. [DOI: 10.1016/j.semarthrit.2015.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/28/2015] [Indexed: 11/25/2022]
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20
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Lugo Reyes SO, Ramirez-Vazquez G, Cruz Hernández A, Medina-Torres EA, Ramirez-Lopez AB, España-Cabrera C, Hernandez-Lopez CA, Yamazaki-Nakashimada MA, Espinosa-Rosales FJ, Espinosa-Padilla SE, Murata C. Clinical Features, Non-Infectious Manifestations and Survival Analysis of 161 Children with Primary Immunodeficiency in Mexico: A Single Center Experience Over two Decades. J Clin Immunol 2015; 36:56-65. [PMID: 26707787 DOI: 10.1007/s10875-015-0226-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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] [Received: 11/01/2014] [Accepted: 12/14/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE The hallmark of Primary immunodeficiencies (PID) is unusual infection, although other immunological non-infectious manifestations such as autoimmunity, allergy and cancer are often present. Most published reports focus on one disease or defect groups, so that a global prevalence of non-infectious manifestations of PID is hard to find. We aimed to describe the clinical features of our pediatric patients with PID, as well as the frequency and evolution of allergy, cancer and autoimmunity. METHODS We reviewed all the available charts of patients being followed for PID from 1991 to the spring of 2012 at the National Institute of Pediatrics, Mexico City, to describe their demographic, clinical and laboratory features. Their diagnoses were established by pediatric immunologists in accordance to ESID criteria, including routine immunological workup and specialized diagnostic assays. We divided patients by decade of diagnosis to analyze their survival curves. RESULTS There were 168 charts available, from which we excluded one duplicate and six equivocal diagnoses. We studied the charts of 161 PID patients (68% male, 86% alive), mostly from the center of the country, with a positive family history in 27% and known consanguinity in 11%. Eighty percent of the patients were diagnosed during the last decade. Current median age was 124 months; median age at onset of infections, 12 months; median age at diagnosis, 52 months; median age at death, 67.5 months. Severe infection and bleeding were the cause of 22 deaths. Eighty-six percent of all patients had at least one infection, while non-infectious manifestations had a global prevalence of 36%, namely: autoimmunity 19%, allergies 17%, and cancer 2.4%. Survival curves were not significantly different when compared by decade of diagnosis. CONCLUSIONS Compared to other registry reports, we found a lower prevalence of antibody defects, and of associated allergy and cancer. We could only locate two isolated IgA deficiencies and four cases of cancer among our PID patients. Although antibody defects are the most prevalent group (30%), the distribution we found is similar to that reported in Iran, Kuwait, Egypt and Taiwan, with a close 27% share for phagocyte defects, and 26% for the formerly called "well-defined" syndromes. Of note, autoimmune and inflammatory complications are high among our patients with chronic granulomatous disease, as has been reported in both the United States and Japan, but not in Europe.
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Affiliation(s)
| | | | - Alonso Cruz Hernández
- Clinical Immunology Department, National Institute of Pediatrics, Mexico City, Mexico
| | - Edgar A Medina-Torres
- Immunodeficiencies Research Unit, National Institute of Pediatrics, Mexico City, Mexico
| | | | - Corín España-Cabrera
- Clinical Immunology Department, National Institute of Pediatrics, Mexico City, Mexico
| | | | | | - Francisco J Espinosa-Rosales
- Immunodeficiencies Research Unit, National Institute of Pediatrics, Mexico City, Mexico
- Clinical Immunology Department, National Institute of Pediatrics, Mexico City, Mexico
| | | | - Chiharu Murata
- Research Methodology Department, National Institute of Pediatrics, Mexico City, Mexico.
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Dorbeker-Azcona R, Bellane-Chantelot C, Olaya-Vargas A, Pérez-García M, Escamilla-Quiroz C, Martínez-Bernal AB, Yamazaki-Nakashimada MA, Blancas-Galicia L. Severe congenital neutropenia with a novel ELANE mutation in 2 Mexican patients. J Investig Allergol Clin Immunol 2014; 24:267-268. [PMID: 25219109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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22
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Álvarez-Cardona A, Rodríguez-Lozano AL, Blancas-Galicia L, Rivas-Larrauri FE, Yamazaki-Nakashimada MA. Intravenous immunoglobulin treatment for macrophage activation syndrome complicating chronic granulomatous disease. J Clin Immunol 2011; 32:207-11. [PMID: 22119934 DOI: 10.1007/s10875-011-9616-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Accepted: 11/08/2011] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Chronic granulomatous disease is a rare phagocyte disorder characterized by an increased susceptibility to infections and inflammatory complications. We describe two patients with chronic granulomatous disease (CGD) complicated by macrophage activation syndrome (MAS) (secondary hemophagocytic lymphohistiocytosis) treated with intravenous immunoglobulin (IVIG). METHODS A report of two cases of CGD complicated by MAS who were successfully treated with IVIG was made, and a comparison was made with ten other cases reported in the literature. RESULTS MAS is a severe potentially fatal complication of CGD. Most cases are associated with Burkholderia cepacia and leishmaniasis infection. The treatment of these patients varies between centers, and one example is the use of the HLH-2004 protocol. IVIG could be an effective first line option for this complication in CGD patients. CONCLUSIONS The exaggerated inflammatory response characteristic of CGD patients could play a role in the development of this complication. IVIG appears to be a safe and effective first line treatment in these patients.
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Affiliation(s)
- Aristóteles Álvarez-Cardona
- Clinical Immunology Department, Instituto Nacional de Pediatría, Insurgentes sur 3700-C, Insurgentes Cuicuilco Coyoacan CP, Mexico City, Mexico
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Randall KL, Chan SSY, Ma CS, Fung I, Mei Y, Yabas M, Tan A, Arkwright PD, Al Suwairi W, Lugo Reyes SO, Yamazaki-Nakashimada MA, Garcia-Cruz MDLL, Smart JM, Picard C, Okada S, Jouanguy E, Casanova JL, Lambe T, Cornall RJ, Russell S, Oliaro J, Tangye SG, Bertram EM, Goodnow CC. DOCK8 deficiency impairs CD8 T cell survival and function in humans and mice. ACTA ACUST UNITED AC 2011; 208:2305-20. [PMID: 22006977 PMCID: PMC3201196 DOI: 10.1084/jem.20110345] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In humans, DOCK8 immunodeficiency syndrome is characterized by severe cutaneous viral infections. Thus, CD8 T cell function may be compromised in the absence of DOCK8. In this study, by analyzing mutant mice and humans, we demonstrate a critical, intrinsic role for DOCK8 in peripheral CD8 T cell survival and function. DOCK8 mutation selectively diminished the abundance of circulating naive CD8 T cells in both species, and in DOCK8-deficient humans, most CD8 T cells displayed an exhausted CD45RA(+)CCR7(-) phenotype. Analyses in mice revealed the CD8 T cell abnormalities to be cell autonomous and primarily postthymic. DOCK8 mutant naive CD8 T cells had a shorter lifespan and, upon encounter with antigen on dendritic cells, exhibited poor LFA-1 synaptic polarization and a delay in the first cell division. Although DOCK8 mutant T cells underwent near-normal primary clonal expansion after primary infection with recombinant influenza virus in vivo, they showed greatly reduced memory cell persistence and recall. These findings highlight a key role for DOCK8 in the survival and function of human and mouse CD8 T cells.
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Affiliation(s)
- Katrina L Randall
- Department of Immunology, The John Curtin School of Medical Research , Australian National University, Canberra, Australian Capital Territory 0200, Australia
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Rodriguez-Lozano AL, Rivas-Larrauri FE, Hernandez-Bautista VM, Yamazaki-Nakashimada MA. Fever is not always present in Kawasaki disease. Rheumatol Int 2011; 32:2953-4. [PMID: 21881982 DOI: 10.1007/s00296-011-2123-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Accepted: 08/22/2011] [Indexed: 12/11/2022]
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Yamazaki-Nakashimada MA, Duran-McKinster C, Ramírez-Vargas N, Hernandez-Bautista V. Intravenous immunoglobulin therapy for hypocomplementemic urticarial vasculitis associated with systemic lupus erythematosus in a child. Pediatr Dermatol 2009; 26:445-7. [PMID: 19689522 DOI: 10.1111/j.1525-1470.2009.00950.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypocomplementemic urticarial vasculitis is a type of urticarial vasculitis with multisystemic involvement and poor prognosis, sometimes associated with systemic lupus erythematosus. Several therapies have been attempted with no consensus on an effective therapeutic regimen. Intravenous immunoglobulin has been used in severe manifestations of systemic lupus erythematosus and recently in hypocomplementemic urticarial vasculitis. We present a 7-year-old girl with hypocomplementemic urticarial vasculitis associated with systemic lupus erythematosus and pneumonia who responded favorably to intravenous immunoglobulin.
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MESH Headings
- Child, Preschool
- Complement System Proteins/metabolism
- Female
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Lupus Erythematosus, Systemic/complications
- Pneumonia/complications
- Treatment Outcome
- Urticaria/blood
- Urticaria/etiology
- Urticaria/pathology
- Urticaria/therapy
- Vasculitis, Leukocytoclastic, Cutaneous/blood
- Vasculitis, Leukocytoclastic, Cutaneous/etiology
- Vasculitis, Leukocytoclastic, Cutaneous/pathology
- Vasculitis, Leukocytoclastic, Cutaneous/therapy
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Yamazaki-Nakashimada MA, Ramírez-Vargas N, De Rubens-Figueroa J. Chronic granulomatous disease associated with atypical Kawasaki disease. Pediatr Cardiol 2008; 29:169-71. [PMID: 17676373 DOI: 10.1007/s00246-007-9011-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Accepted: 06/11/2007] [Indexed: 11/30/2022]
Abstract
Chronic granulomatous disease (CGD) is an infrequent inherited disorder characterized by recurrent infections and abnormal granuloma formation. Patients with CGD have an exuberant inflammatory response and an increased risk of developing autoimmunity. We present the case of a 1-year-old boy with CGD who developed several of the characteristic clinical features of Kawasaki Disease. His illness responded to intravenous immunoglobulin, aspirin, and corticosteroids.
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Affiliation(s)
- M A Yamazaki-Nakashimada
- Department of Clinical Immunology, Instituto Nacional de Pediatría, Insurgentes Sur 3700-C C.P, 04530, Col. Insurgentes Cuicuilco, Mexico City, Mexico.
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Yamazaki-Nakashimada MA, Stiehm ER, Pietropaolo-Cienfuegos D, Hernandez-Bautista V, Espinosa-Rosales F. Corticosteroid therapy for refractory infections in chronic granulomatous disease: case reports and review of the literature. Ann Allergy Asthma Immunol 2006; 97:257-61. [PMID: 16937761 DOI: 10.1016/s1081-1206(10)60023-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Chronic granulomatous disease (CGD) is a primary phagocyte immunodeficiency. It is often accompanied by an exuberant and aberrant inflammatory response, with granulomata and obstruction of the gastrointestinal and genitourinary tracts and inflammatory bowel disease. Although corticosteroids are successful in managing the obstructive and inflammatory disorders of CGD, they are not ordinarily used for the management of infection because of the possibility of further compromising the patient's immune system. OBJECTIVES To discuss the pros and cons of the use of corticosteroids for the treatment of infections in CGD. METHODS We describe 2 patients with CGD and refractory infections who were successfully treated with systemic corticosteroids in addition to antimicrobial agents. We also review the medical literature in which corticosteroids have been used for CGD infection. RESULTS Our cases add to 3 other reports in which antibiotics and corticosteroids were used successfully in patients with CGD. However, in the presence of a potential pathogen, notably, aspergilla, corticosteroids may mask or favor dissemination of the fungus, especially in adults. CONCLUSIONS Corticosteroids may play an important adjunctive role in CGD refractory infections.
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Yamazaki-Nakashimada MA, Espinosa-Lopez M, Hernandez-Bautista V, Espinosa-Padilla S, Espinosa-Rosales F. Catastrophic Kawasaki Disease or Juvenile Polyarteritis Nodosa? Semin Arthritis Rheum 2006; 35:349-54. [PMID: 16765711 DOI: 10.1016/j.semarthrit.2006.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Juvenile Polyarteritis nodosa (PAN) and Kawasaki Disease (KD) are disseminated vasculitides of unknown cause affecting small- and medium-sized vessels in children. We present an unusually severe case that fulfilled criteria for both KD and PAN. The diagnosis, overlapping clinical features, and treatment options for the 2 diseases are discussed. METHODS A 3-year-old girl with systemic vasculitis is presented. We compare our case to 4 other cases reported in the literature which presented with a similar diagnostic dilemma. A review of the medical literature and a qualitative analysis of the diseases were performed, with emphasis on overlapping features, atypical cases, and treatment options. RESULTS Many features of KD and PAN are shared; however, there are some clinical features that could help differentiate one from the other. Fever, weight loss, rash, abdominal pain, arthritis, coronary arteritis, peripheral gangrene, anemia, leukocytosis, thrombocytosis, and elevated C-reactive protein are among many of the features that are shared by both diseases. However, KD also has unique clinical features that include conjunctivitis, changes in the lips and mouth, desquamation of the fingertips, and gallbladder hydrops, whereas renal involvement in KD is rare. CONCLUSIONS Occasionally juvenile PAN and KD share clinical manifestations, and when they do, it may be impossible to differentiate between them. Treatment should be directed according to the severity and persistence of these clinical manifestations.
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Ruiz-Maldonado R, Durán-McKinster C, Sáez-de-Ocariz M, Calderón-Elvir C, Yamazaki-Nakashimada MA, Orozco-Covarrubias L. Interferon alpha-2B in juvenile hyaline fibromatosis. Clin Exp Dermatol 2006; 31:478-9. [PMID: 16681619 DOI: 10.1111/j.1365-2230.2006.02089.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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