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Mertz P, Hentgen V, Boursier G, Delon J, Georgin-Lavialle S. [Monogenic auto-inflammatory diseases associated with actinopathies: A review of the literature]. Rev Med Interne 2023; 44:585-593. [PMID: 37596178 DOI: 10.1016/j.revmed.2023.06.005] [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: 05/03/2023] [Accepted: 06/06/2023] [Indexed: 08/20/2023]
Abstract
Auto-inflammatory diseases (AIDs) are diseases resulting from an inappropriate activation of innate immunity in the absence of any infection. The field of monogenic AIDs is constantly expanding, with the discovery of new pathologies and pathophysiological mechanisms thanks to pangenomic sequencing. Actinopathies with auto-inflammatory manifestations are a new emerging group of AIDs, linked to defects in the regulation of the actin cytoskeleton dynamics. These diseases most often begin in the neonatal period and combine to varying degrees a more or less severe primary immune deficiency, cytopenias (especially thrombocytopenia), auto-inflammatory manifestations (especially cutaneous and digestive), atopic and auto-immune manifestations. The diagnosis is to be evoked essentially in front of a cutaneous-digestive auto-inflammation picture of early onset, associated with a primary immune deficiency and thrombocytopenia or a tendency to bleed. Some of these diseases have specificities, including a risk of macrophagic activation syndrome or a tendency to atopy or lymphoproliferation. We propose here a review of the literature on these new diseases, with a proposal for a practical approach according to the main associated biological abnormalities and some clinical particularities. However, the diagnosis remains genetic, and several differential diagnoses must be considered. The pathophysiology of these diseases is not yet fully elucidated, and studies are needed to better clarify the inherent mechanisms that can guide the choice of therapies. In most cases, the severity of the picture indicates allogeneic marrow transplantation.
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Affiliation(s)
- P Mertz
- Service de rhumatologie, hôpitaux universitaires de Strasbourg, centre national de référence RESO, 67000 Strasbourg, France
| | - V Hentgen
- Service de pédiatrie, centre hospitalier de Versailles, centre de référence des maladies auto-inflammatoires et de l'amylose (CEREMAIA), 78150 Le Chesnay, France
| | - G Boursier
- Service de génétique moléculaire et cytogénomique, laboratoire de référence des maladies rares et auto-inflammatoires, CEREMAIA, IRMB, Inserm, CHU de Montpellier, université de Montpellier, Montpellier, France
| | - J Delon
- Université Paris Cité, institut Cochin, Inserm, CNRS, 75014 Paris, France
| | - S Georgin-Lavialle
- Service de médecine interne, DHU32D, département hospitalo-universitaire Inflammation, immunopathologie, biothérapie, hôpital Tenon, université Paris, Sorbonne université, Assistance publique-Hôpitaux de Paris (AP-HP), 4, rue de la Chine, 75020 Paris, France; CHU de Tenon, centre de référence des maladies auto-inflammatoires rares et de l'amylose inflammatoire (CEREMAIA), 75020 Paris, France.
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Bruneau J, Khater S, Isnard P, Lhermitte L, Brouzes C, Sibon D, Asnafi V, Berrebi D, Rabant M, Neven B, Cellier C, Hermine O, Molina TJ. [Immunopathology of the small intestine]. Ann Pathol 2023:S0242-6498(23)00080-9. [PMID: 37156715 DOI: 10.1016/j.annpat.2023.03.004] [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] [Received: 02/15/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 05/10/2023]
Abstract
The gastrointestinal tract is the site of exciting immunological interactions between the epithelium and the mucosa-associated lymphoid tissue, leading to the immune response to food and microbial antigens in the digestive lumen. The objective of this review is to present the main dysimmune pathologies of the digestive tract leading to an enteropathy. As examples, we describe celiac and non-celiac enteropathies to clarify a florid diagnostic framework, by identifying a spectrum of elementary lesions, which must be confronted with the clinico biological context of the patient to orient the diagnosis. The microscopic lesions observed are most often non-specific and may be encountered in several diagnostic settings. Moreover, it is a set of elementary lesions in each clinical context that will orient the diagnostic framework. Celiac disease is the main etiology of enteropathy with villous atrophy, its diagnosis is multidisciplinary and there are many differential diagnoses. We will discuss celiac disease lymphomatous complications as enteropathy associated T-cell lymphoma including refractory sprue type 2. We will then present the non-celiac enteropathies. Among these, enteropathies of unknown etiology may be associated with a primary immune deficiency that may be reflected by florid lymphoid hyperplasia of the gastrointestinal tract and/or be associated with an infectious etiology that should also be constantly sought. Finally, we will discuss of induced enteropathy by new immunomodulatory treatments.
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Affiliation(s)
- Julie Bruneau
- Service d'anatomie et de cytologie pathologique, hôpitaux universitaires Necker-Enfants Malades et Robert Debré, AP-HP, université de Paris Cité, Paris, France.
| | - Shérine Khater
- Service de gastro-entérologie, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris Cité, Paris, France
| | - Pierre Isnard
- Service d'anatomie et de cytologie pathologique, hôpitaux universitaires Necker-Enfants Malades et Robert Debré, AP-HP, université de Paris Cité, Paris, France
| | - Ludovic Lhermitte
- Laboratoire d'onco-hématologie, hôpital universitaire Necker-Enfants Malades, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris Cité, Paris, France
| | - Chantal Brouzes
- Laboratoire d'onco-hématologie, hôpital universitaire Necker-Enfants Malades, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris Cité, Paris, France
| | - David Sibon
- Service d'hématologie, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris-Est-Créteil, Créteil, France
| | - Vahid Asnafi
- Laboratoire d'onco-hématologie, hôpital universitaire Necker-Enfants Malades, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris Cité, Paris, France
| | - Dominique Berrebi
- Service d'anatomie et de cytologie pathologique, hôpitaux universitaires Necker-Enfants Malades et Robert Debré, AP-HP, université de Paris Cité, Paris, France
| | - Marion Rabant
- Service d'anatomie et de cytologie pathologique, hôpitaux universitaires Necker-Enfants Malades et Robert Debré, AP-HP, université de Paris Cité, Paris, France
| | - Bénédicte Neven
- Service d'immuno-hématologie et rhumatologie pédiatrique, hôpital universitaire Necker-Enfants Malades, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris Cité, Paris, France
| | - Christophe Cellier
- Service de gastro-entérologie, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris Cité, Paris, France
| | - Olivier Hermine
- Service d'hématologie, hôpital universitaire Necker-Enfants Malades, Assistance publique-Hôpitaux de Paris, AP-HP, université Paris Cité, Paris, France
| | - Thierry Jo Molina
- Service d'anatomie et de cytologie pathologique, hôpitaux universitaires Necker-Enfants Malades et Robert Debré, AP-HP, université de Paris Cité, Paris, France
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Gaigne L, Piperoglou C, Banzet N, Ghellab L, Vély F, Schleinitz N, Ebbo M. [Anti-cytokine autoantibodies: Review of the literature]. Rev Med Interne 2022; 43:528-536. [PMID: 35820937 DOI: 10.1016/j.revmed.2022.06.006] [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] [Received: 02/25/2022] [Revised: 05/23/2022] [Accepted: 06/12/2022] [Indexed: 11/28/2022]
Abstract
Anti-cytokine antibodies (ACA) are an emerging cause of acquired immunodeficiency, especially in previously healthy adults. The most frequently reported are anti-IFN-γ responsible for disseminated non-tuberculous mycobacteria infections, and anti-GM-CSF mainly in mycobacteria, cryptococcosis and nocardiosis infections. The presence of anti-IFN-α in severe COVID-19 infections has recently been described. The search for and detection of these ACAs in an unusual infection situation makes it possible to set up specific therapies in addition to the anti-infective treatment. ACAs are also frequent in various autoimmune pathologies where, in addition to being indicators of the breakdown of immune tolerance, they can modulate the activity of the disease according to their cytokine target. In this review of the literature, we will focus on the epidemiology and the clinical impact of these ACAs in healthy subjects and in infectious or dysimmune diseases.
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Affiliation(s)
- L Gaigne
- Département de médecine interne, hôpital La Timone, CHU de Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, Marseille, France.
| | - C Piperoglou
- Marseille immunopôle, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, Marseille, France
| | - N Banzet
- Marseille immunopôle, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, Marseille, France
| | - L Ghellab
- Marseille immunopôle, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, Marseille, France
| | - F Vély
- Marseille immunopôle, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, Marseille, France; CNRS, Inserm, CIML, Aix Marseille université, Marseille, France
| | - N Schleinitz
- Département de médecine interne, hôpital La Timone, CHU de Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, Marseille, France; Marseille immunopôle, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, Marseille, France
| | - M Ebbo
- Département de médecine interne, hôpital La Timone, CHU de Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, Marseille, France; Marseille immunopôle, hôpital de la Timone, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, Marseille, France
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Parentelli AS, Picard C, Boursier G, Melki I, Belot A, Smahi A, Georgin-Lavialle S. [Autoinflammatory diseases associated with RIPK1 mutations: A review of the literature]. Rev Med Interne 2022; 43:552-558. [PMID: 35786329 DOI: 10.1016/j.revmed.2022.06.005] [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: 06/07/2022] [Accepted: 06/12/2022] [Indexed: 11/19/2022]
Abstract
Autoinflammatory diseases related to RIPK1 mutations have been recently described. Two distinct clinical phenotypes have been reported and depend on the type and location of the mutation. When the mutation is recessive with loss of function, patients develop a combined phenotype of immune deficiency with recurrent bacterial and fungal infections and signs of early inflammatory bowel disease, non-erosive polyarthritis and growth retardation. On the other hand, when the mutation is dominant, gain of function, the manifestations are only auto-inflammatory with extensive lymphoproliferation, oral lesions such as aphthosis or ulcers, abdominal pain and hepatosplenomegaly. The mutations described for the dominant form affect only the cleavage site of caspase 8 and the clinical phenotype is called CRIA for Cleavage-Resistant RIPK1-Induced Autoinflammatory syndrome. The recessive form is severe and life-threatening requiring hematopoietic stem cell transplantation while the dominant form responds well to interleukin-6 receptor antagonists. Thus, RIPK1 mutations can induce various clinical manifestations with two distinct phenotypes. Although still rare, because of their recent description, these diseases can be suspected by an internist, in front of recurrent digestive features and will be increasingly diagnosed in the future through the integration of this gene in the diagnostic chips dedicated to autoinflammatory diseases and early inflammatory bowel diseases, using next generation sequencing.
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Affiliation(s)
- A S Parentelli
- Service des urgences pédiatriques, hôpital Robert-Debré, Assistance Publique des hôpitaux de Paris (AP-HP), 48, boulevard Sérurier, 75019 Paris, France; Institut Imagine, Inserm U1163, CNRS ERL 8254, université Paris Cité, Sorbonne Paris-Cité, Laboratoire d'excellence GR-Ex, Paris, France
| | - C Picard
- Centre d'études des déficits immunitaires (CEDI), département médico-universitaire BioPhyGen, hôpital Necker enfants malades, AP-HP, 149, rue de Sèvres, 75743 Paris Cedex 15, France; Université Paris Cité, Paris, France; Laboratoire d'Activation des Lymphocytes et Susceptibilité au virus EBV, Inserm UMR 1163, Institut Imagine, Paris, France; Centre de référence des déficits immunitaires héréditaires (CEREDIH), hôpital Necker-Enfants Malades, AP-HP, 149, rue de Sèvres, 75743 Paris Cedex 15, France
| | - G Boursier
- Laboratoire de génétique des maladies rares et auto-inflammatoires, service de génétique moléculaire et cytogénomique, CHU de Montpellier, Université de Montpellier, 371, avenue du Doyen Gaston-Giraud, 34295 Montpellier Cedex 5, France; Centre de référence des maladies Auto-Inflammatoires rares et de l'Amylose Inflammatoire (CEREMAIA), hôpital de Tenon, AP-HP, 75020 Paris, France
| | - I Melki
- Service de pédiatrie générale, maladies infectieuses et médecine interne pédiatrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Centre de référence des rhumatismes et auto-immunité systémique de l'enfant (RAISE), hôpital Necker Enfants Malades, AP-HP, 149, rue de Sèvres, 75743 Paris Cedex 15, France
| | - A Belot
- CIRI, Inserm U1111, service de néphrologie, rhumatologie, dermatologie pédiatrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, université de Lyon 1, 69677 Bron, France; Centre de référence des rhumatismes et auto-immunité systémique de l'enfant (RAISE), hôpital Necker Enfants Malades, AP-HP, 149, rue de Sèvres, 75743 Paris Cedex 15, France
| | - A Smahi
- Institut Imagine, Inserm U1163, CNRS ERL 8254, université Paris Cité, Sorbonne Paris-Cité, Laboratoire d'excellence GR-Ex, Paris, France
| | - S Georgin-Lavialle
- Département de médecine interne, DHUI2B, département hospitalo-universitaire inflammation, immunopathologie, biothérapie, hôpital Tenon, université Paris 6, Pierre et Marie Curie, AP-HP, 4, rue de la Chine, 75020 Paris, France; Centre de référence des maladies Auto-Inflammatoires rares et de l'Amylose Inflammatoire (CEREMAIA), hôpital de Tenon, AP-HP, 75020 Paris, France.
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Baghad B, Benhsaien I, El Fatoiki FZ, Migaud M, Puel A, Chiheb S, Bousfiha AA, Ailal F. [Chronic mucocutaneous candidiasis with STAT1 gain-of-function mutation associated with herpes virus and mycobacterial infections]. Ann Dermatol Venereol 2019; 147:41-45. [PMID: 31677808 DOI: 10.1016/j.annder.2019.09.597] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/19/2019] [Revised: 05/04/2019] [Accepted: 09/19/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Chronic mucocutaneous candidiasis (CMC) is characterized by susceptibility to chronic or recurrent infections with yeasts of the genus Candida affecting the skin, nails and mucous membranes. We describe a Moroccan patient presenting CMC with heterozygous STAT1 gain-of-function (GOF) mutation. PATIENTS AND METHODS A 5-year-old boy with no consanguinity presented recurrent episodes of oral thrush, chronic nail candidiasis and herpetic gingivostomatitis from the age of 8 months. He also had mycobacterial adenitis secondary to BCG vaccination and atypical rosacea. Genetic analysis revealed GOF mutation of the STAT1 gene. DISCUSSION CMC was diagnosed in our patient despite poor clinical features. Sequencing of the genome revealed STAT1GOF mutation. This mutation affects production of IL-17, an important cytokine in mucocutaneous defense against Candida. The association with mycobacterial adenitis is rare and continues to be poorly understood. The presence of atypical rosacea in this setting is suggestive of this entity. Antifungal therapy and prevention of complications are necessary to reduce the morbidity and mortality associated with this condition. CONCLUSION CMC due to STAT1GOF mutation is characterized by a broad clinical spectrum and should be considered in all cases of chronic or recurrent fungal infection, whether or not associated with other infections.
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Affiliation(s)
- B Baghad
- Service de dermatologie vénéréologie, CHU de Casablanca, Maroc; Laboratoire d'immunologie clinique, inflammation et allergie, faculté de médecine et de pharmacie de Casablanca, Hassan II University of Casablanca, Maroc.
| | - I Benhsaien
- Laboratoire d'immunologie clinique, inflammation et allergie, faculté de médecine et de pharmacie de Casablanca, Hassan II University of Casablanca, Maroc; Unité d'immunologie clinique, service de pédiatrie infectieuse, CHU Harrouchi, Casablanca, Maroc
| | - F Z El Fatoiki
- Service de dermatologie vénéréologie, CHU de Casablanca, Maroc; Laboratoire d'immunologie clinique, inflammation et allergie, faculté de médecine et de pharmacie de Casablanca, Hassan II University of Casablanca, Maroc
| | - M Migaud
- Laboratoire de génétique humaine des maladies infectieuses, Necker Branch, Inserm U1163, 75015 Paris, France; Institut imagine, université Paris Descartes, 75015 Paris, France
| | - A Puel
- Laboratoire de génétique humaine des maladies infectieuses, Necker Branch, Inserm U1163, 75015 Paris, France; Institut imagine, université Paris Descartes, 75015 Paris, France
| | - S Chiheb
- Service de dermatologie vénéréologie, CHU de Casablanca, Maroc
| | - A A Bousfiha
- Laboratoire d'immunologie clinique, inflammation et allergie, faculté de médecine et de pharmacie de Casablanca, Hassan II University of Casablanca, Maroc; Unité d'immunologie clinique, service de pédiatrie infectieuse, CHU Harrouchi, Casablanca, Maroc
| | - F Ailal
- Laboratoire d'immunologie clinique, inflammation et allergie, faculté de médecine et de pharmacie de Casablanca, Hassan II University of Casablanca, Maroc; Unité d'immunologie clinique, service de pédiatrie infectieuse, CHU Harrouchi, Casablanca, Maroc
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Martin C, Regard L, Chassagnon G, Burgel PR. [Bronchiectasis in adults: Etiological diagnosis]. Rev Pneumol Clin 2018; 74:292-298. [PMID: 30318255 DOI: 10.1016/j.pneumo.2018.09.011] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Bronchiectasis is defined by a permanent and irreversible increase in airway caliber. Computed tomography (CT) scan is required for diagnosis and allows differentiating localized (affecting only one lobe) from diffuse (affecting two or more lobes) bronchiectasis. Localized bronchiectasis is usually related to a local cause (e.g., tumor, compression by lymph nodes, foreign body) whereas there are multiple causes of diffuse bronchiectasis. Main causes of diffuse bronchiectasis can be grouped into 5 categories: (1) immune deficiencies; (2) genetic disorders responsible for abnormal mucociliairy clearance (e.g., cystic fibrosis and primary ciliary dyskinesia); (3) autoinflammatory and connective tissue diseases (e.g., rheumatoid arthritis, Sjogren syndrome); (4) chronic airway inflammatory disorders (e.g., allergic broncho-pulmonary aspergillosis) or chronic infections (e.g., by nontuberculous mycobacteria) and; (5) sequelae of pulmonary insults (e.g., infection, radiotherapy). In the absence of a specific cause, bronchiectasis are called idiopathic. Bronchoscopy is the cornerstone for etiological diagnosis in localized bronchiectasis. Investigation of diffuse bronchiectasis includes standardized biological tests, eventually completed by specialized explorations (e.g., analysis of epithelial ion transport and/or ciliary beating). After this systematic approach, an etiological diagnosis is obtained in approximately 60% of cases, often resulting in therapeutic consequences and in some cases in genetic counselling.
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Affiliation(s)
- C Martin
- Service de pneumologie, centre de référence maladies rares mucoviscidose et affections liées à une anomalie de CFTR (site coordonnateur), hôpital Cochin, Assistance publique des hôpitaux de Paris (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - L Regard
- Service de pneumologie, centre de référence maladies rares mucoviscidose et affections liées à une anomalie de CFTR (site coordonnateur), hôpital Cochin, Assistance publique des hôpitaux de Paris (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - G Chassagnon
- Unité thoracique, service de radiologie, hôpital Cochin, Assistance publique des hôpitaux de Paris, 75014 Paris, France
| | - P-R Burgel
- Service de pneumologie, centre de référence maladies rares mucoviscidose et affections liées à une anomalie de CFTR (site coordonnateur), hôpital Cochin, Assistance publique des hôpitaux de Paris (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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Vautier M, Georgin-Lavialle S, Hermine O, Bienvenu B, Lacaze E, Gerard M, Aouba A. [Efficiency and good tolerance of rituximab for idiopathic thrombocytopenic purpura revealing a 22q11 deletion syndrome]. Rev Med Interne 2016; 37:766-770. [PMID: 26869291 DOI: 10.1016/j.revmed.2016.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/16/2015] [Revised: 11/23/2015] [Accepted: 01/12/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION 22q11 deletion is a common genetic disorder which associates a polymalformative syndrome to dysimmune features. Autoimmunity and immune deficiency manifestations are often associated, resulting in a therapeutic challenge for this disease. CASE REPORT We report a 28-year-old patient who presented with hemorrhagic manifestations leading to the diagnosis of severe thrombocytopenia (15,000/mm3), of both central and peripheral origin. Patient history, cardio-facial malformative syndrome, hypoparathyroidism and partial immune deficiency led to the molecular diagnosis of 22q11 deletion syndrome. After failure of polyvalent immunoglobulin infusions, rituximab alone allowed the increase of platelets to their usual level of 100-120,000/mm3 within 4 weeks and a complete clinical remission of the hemorrhagic syndrome, without any infectious complication after a 4-year follow-up. CONCLUSION Rituximab may be an alternative to corticosteroid for the treatment of auto-immune manifestations associated with minor forms of 22q11 deletion syndrome without significant worsening of the immune deficiency.
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Affiliation(s)
- M Vautier
- Service de médecine interne, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 09, France.
| | - S Georgin-Lavialle
- Service de médecine interne, hôpital Tenon, 75020 Paris, France; Service d'hématologie adulte, hôpital Necker-Enfants malades, 75015 Paris, France
| | - O Hermine
- Service d'hématologie adulte, hôpital Necker-Enfants malades, 75015 Paris, France
| | - B Bienvenu
- Service de médecine interne, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 09, France
| | - E Lacaze
- Service de génétique, CHU de Caen, 14000 Caen, France
| | - M Gerard
- Service de génétique, CHU de Caen, 14000 Caen, France
| | - A Aouba
- Service de médecine interne, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 09, France; Service d'hématologie adulte, hôpital Necker-Enfants malades, 75015 Paris, France
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Locatelli A, Béné MC, Zuily S, Angioi-Duprez K. [Ocular manifestations in chronic granulomatous disease]. J Fr Ophtalmol 2013; 36:789-95. [PMID: 24099698 DOI: 10.1016/j.jfo.2013.07.002] [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] [Received: 04/22/2012] [Revised: 07/02/2013] [Accepted: 07/05/2013] [Indexed: 11/15/2022]
Abstract
Chronic granulomatous disease (CGD) is a rare genetic immune deficiency due to defective oxygen metabolism in phagocytic cells. It results in recurrent severe bacterial and fungal infections in patients from an early age on. Inflammatory lesions are also observed, with the formation of granulomas. Diagnosis relies on the demonstration of a deficiency in the oxidative properties of phagocytes. Pulmonary infections are the most frequent clinical manifestations of the disease, yet all organs can be involved, such as the eye, with either infections or inflammatory chorioretinal lesions. The treatment of CGD relies on prophylaxis to avoid infections, and on the rapid management of infectious and inflammatory episodes. The only cure to date is allogenetic bone marrow transplant, which requires a compatible donor and can only be considered in certain clinical situations.
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Affiliation(s)
- A Locatelli
- Service d'ophtalmologie, CHU de Nancy-Brabois, allée du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France
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