1
|
Mu J, Xue D, Li M, Wang T, Ma Q, Dong H. Fatal unexpected death due to X-linked lymphoproliferative disease. Leg Med (Tokyo) 2021; 52:101900. [PMID: 34023582 DOI: 10.1016/j.legalmed.2021.101900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 04/13/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
X-linked lymphoproliferative disease (XLP) is a rare immunodeficiency disease characterized by severe immune disorder and extreme vulnerability to Epstein-Barr virus (EBV) infections. Here we report a 14-month-old Chinese boy presenting with fulminant infectious mononucleosis (FIM) following EBV infection, and died of hepatic failure within one week of disease progression. Postmortem examination revealed icterus, ascites, extensive enlarged mesenteric lymphnodes and hepatosplenomegaly. Histopathological examination showed diffuse proliferation of cytotoxic T lymphoid cells and hemophagocytosis in multiple organs. The family history revealed his brother had died under similar circumstances at 5 five years of age. The cause of death of the boy was ascribed to XLP. To the best of our knowledge, there is few autopsy-confirmed XLP case in the forensic practice. The complicatedmanifestations and systemic pathological changes should be well recognized by clinicians and forensic pathologists.
Collapse
Affiliation(s)
- Jiao Mu
- Department of Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, PR China; Department of Forensic Medicine, Hebei North University, No. 11 Zuanshinan Road, Zhangjiakou, Hebei 075000, PR China.
| | - Dazhong Xue
- Department of Forensic Medicine, Hebei North University, No. 11 Zuanshinan Road, Zhangjiakou, Hebei 075000, PR China.
| | - Meiyu Li
- Department of Forensic Medicine, Hebei North University, No. 11 Zuanshinan Road, Zhangjiakou, Hebei 075000, PR China.
| | - Tingting Wang
- Department of Forensic Medicine, Hebei North University, No. 11 Zuanshinan Road, Zhangjiakou, Hebei 075000, PR China.
| | - Qian Ma
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, Hubei 430030, PR China.
| | - Hongmei Dong
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, Hubei 430030, PR China.
| |
Collapse
|
2
|
Biank VF, Sheth MK, Talano J, Margolis D, Simpson P, Kugathasan S, Stephens M. Association of Crohn's disease, thiopurines, and primary epstein-barr virus infection with hemophagocytic lymphohistiocytosis. J Pediatr 2011; 159:808-12. [PMID: 21722918 PMCID: PMC3191286 DOI: 10.1016/j.jpeds.2011.04.045] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 04/08/2011] [Accepted: 04/28/2011] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the incidence of hemophagocytic lymphohistiocytosis (HLH) in a well-defined population of children with inflammatory bowel disease (IBD) and evaluate the common clinical and laboratory characteristics of individuals with IBD who developed HLH. STUDY DESIGN We conducted a retrospective study of all children who developed HLH over an 8-year period. The incidence of HLH in patients with IBD was calculated using US census data and a statewide project examining the epidemiology of pediatric IBD. RESULTS Among children in Wisconsin, 20 cases of HLH occurred during the study period; 5 cases occurred in children with IBD. Common characteristics include: Crohn's disease (CD), thiopurine administration, fever lasting more than 5 days, lymphadenopathy, splenomegaly, anemia, lymphopenia, and elevated serum triglycerides and ferritin. Of the patients, 4 had primary Epstein-Barr virus infections. The incidence of HLH among all children in Wisconsin was 1.5 per 100 000 per year. The risk was more than 100-fold greater for children with CD (P < .00001). CONCLUSIONS Pediatric patients with CD are at increased risk for developing HLH; primary Epstein-Barr virus infection and thiopurine administration may be risk factors.
Collapse
Affiliation(s)
- Vincent F. Biank
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Medical College of Wisconsin, The Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mehul K. Sheth
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Medical College of Wisconsin, The Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Julie Talano
- Department of Pediatrics, Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, The Medical College of Wisconsin, The Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - David Margolis
- Department of Pediatrics, Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, The Medical College of Wisconsin, The Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pippa Simpson
- Department of Pediatrics, Division of Quantitative Health Services, The Medical College of Wisconsin, Milwaukee Wisconsin, USA
| | - Subra Kugathasan
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Michael Stephens
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Medical College of Wisconsin, The Children’s Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
3
|
Weber T, Ettrich T, Christopeit M, Lindner A, Holzhausen HJ, Oehme A, Arnold D, Wolf HH, Lübbert C, Kekulé AS, Schmoll HJ, Werdan K, Ebelt H. [Unexplained fever and B-symptoms in a young male Black African]. Internist (Berl) 2011; 53:93-8. [PMID: 21953027 DOI: 10.1007/s00108-011-2912-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An immunocompetent Nigerian developed a fulminant hemophagocytic lymphohistiocytosis due to Epstein-Barr virus reactivation. The patient initially presented with fever, hepatosplenomegaly and pancytopenia. The clinical status of our patient deteriorated quickly despite treatment with corticoids. Escalation of immunosuppressive treatment was not possible. He died of lung, liver and circulatory failure in our intensive care unit.Hemophagocytic lymphohistiocytosis is a rare disease characterized by inflammation due to prolonged and excessive activation of antigen-presenting cells. High plasma ferritin levels and phagocytosis of hematopoetic cells in bone marrow, spleen and liver lead to the diagnosis. Hemophagocytic lymphohistiocytosis should therefore be included in the differential diagnosis in patients with persistent fever, hepatosplenomegaly and cytopenia.
Collapse
Affiliation(s)
- T Weber
- Klinik und Poliklinik für Innere Medizin IV, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Chen G, Tai AK, Lin M, Chang F, Terhorst C, Huber BT. Signaling Lymphocyte Activation Molecule-Associated Protein Is a Negative Regulator of the CD8 T Cell Response in Mice. THE JOURNAL OF IMMUNOLOGY 2005; 175:2212-8. [PMID: 16081788 DOI: 10.4049/jimmunol.175.4.2212] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The primary manifestation of X-linked lymphoproliferative syndrome, caused by a dysfunctional adapter protein, signaling lymphocyte activation molecule-associated protein (SAP), is an excessive T cell response upon EBV infection. Using the SAP-/- mouse as a model system for the human disease, we compared the response of CD8+ T cells from wild-type (wt) and mutant mice to various stimuli. First, we observed that CD8+ T cells from SAP-/- mice proliferate more vigorously than those from wt mice upon CD3/CD28 cross-linking in vitro. Second, we analyzed the consequence of SAP deficiency on CTL effector function and homeostasis. For this purpose, SAP-/- and wt mice were infected with the murine gamma-herpesvirus 68 (MHV-68). At 2 wk postinfection, the level of viral-specific CTL was much higher in mutant than in wt mice, measured both ex vivo and in vivo. In addition, we established that throughout 45 days of MHV-68 infection the frequency of virus-specific CD8+ T cells producing IFN-gamma was significantly higher in SAP-/- mice. Consequently, the level of latent infection by MHV-68 was considerably lower in SAP-/- mice, which indicates that SAP-/- CTL control this infection more efficiently than wt CTL. Finally, we found that the Vbeta4-specific CD8+ T cell expansion triggered by MHV-68 infection is also enhanced and prolonged in SAP-/- mice. Taken together, our data indicate that SAP functions as a negative regulator of CD8+ T cell activation.
Collapse
MESH Headings
- Animals
- Antigens, CD
- BALB 3T3 Cells
- CD28 Antigens/immunology
- CD28 Antigens/metabolism
- CD3 Complex/immunology
- CD3 Complex/metabolism
- CD8-Positive T-Lymphocytes/cytology
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/metabolism
- CD8-Positive T-Lymphocytes/virology
- Cell Differentiation/genetics
- Cell Differentiation/immunology
- Cell Line, Tumor
- Cell Proliferation
- Cross-Linking Reagents/metabolism
- Cytotoxicity, Immunologic/genetics
- Down-Regulation/immunology
- Epitopes, T-Lymphocyte/immunology
- Gammaherpesvirinae/immunology
- Glycoproteins/metabolism
- Herpesviridae Infections/genetics
- Herpesviridae Infections/immunology
- Immunoglobulins/metabolism
- Intracellular Signaling Peptides and Proteins/deficiency
- Intracellular Signaling Peptides and Proteins/genetics
- Intracellular Signaling Peptides and Proteins/physiology
- Lymphocyte Activation/genetics
- Lymphocyte Activation/immunology
- Lymphocyte Count
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Cell Surface
- Signal Transduction/immunology
- Signaling Lymphocytic Activation Molecule Associated Protein
- Signaling Lymphocytic Activation Molecule Family Member 1
- Spleen/cytology
- Spleen/immunology
- Spleen/virology
- Virus Latency/immunology
Collapse
Affiliation(s)
- Gang Chen
- Department of Pathology, Tufts University School of Medicine, Boston, MA 02111, USA
| | | | | | | | | | | |
Collapse
|
5
|
Jaffe R. Liver involvement in the histiocytic disorders of childhood. Pediatr Dev Pathol 2004; 7:214-25. [PMID: 15022067 DOI: 10.1007/s10024-003-9876-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2003] [Accepted: 06/02/2003] [Indexed: 12/15/2022]
Abstract
The liver can be involved directly, by infiltration, and indirectly--by remote effects--in the histiocytoses of childhood. Langerhans cell disease, the most well recognized of these, infiltrates the liver directly but has a remarkable selectivity for the bile ducts. Early involvement is by Langerhans cell histiocytosis (LCH) infiltration leading to a sclerosing cholangitis and, eventually, biliary cirrhosis. Gamma glutamyl transpeptidase is a sensitive indicator of liver infiltration in a child with LCH. The indirect effects on the liver of LCH elsewhere in the body are mediated through an accompanying macrophage activation syndrome that is most likely responsible for hepatomegaly and hypoalbuminemia but without direct infiltration. These indirect effects are completely reversible. Juvenile xanthogranuloma/xanthoma disseminatum, a related dendritic cell disorder that can have systemic manifestations, has a strikingly different pattern, with a predominantly portal infiltrate spilling over into the adjacent lobule but sparing the biliary tree. The biology of the liver lesions is not clear but regression has been documented. Myeloproliferative disorders and myeloid leukemias can express CD1a and/or S100 protein, mimicking LCH but distinguished by their sinusoidal pattern. The primary macrophage histiocytoses such as the familial hemophagocytic syndromes can lead to severe liver damage. Although a portal lymphohistiocytic infiltrate is most characteristic, it is probably cytokine-mediated hepatocellular damage that can cause substantial functional impairment or even hepatic failure as a presenting feature. Liver involvement in other, more unusual histiocytic disorders, is also illustrated.
Collapse
Affiliation(s)
- Ronald Jaffe
- Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA.
| |
Collapse
|
6
|
Nagy N, Mattsson K, Maeda A, Liu A, Székely L, Klein E. The X-linked lymphoproliferative disease gene product SAP is expressed in activated T and NK cells. Immunol Lett 2002; 82:141-7. [PMID: 12008045 DOI: 10.1016/s0165-2478(02)00029-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The unique manifestation of the inherited immunodeficiency, X-linked lymphoproliferative disease (XLP), is the impaired control of EBV infection. The gene, which carries mutations or is deleted in the patients, has been identified (Xq25). The encoded protein (SAP, 128 aa) contains a single SH2 domain and binds to signaling lymphocytic activation molecule (SLAM) and to other related surface molecules that are expressed on activated T, B and NK cells. SAP modifies signal transduction through its association with these molecules. Initially it was assumed that SAP acts passively by interfering and blocking active interactions involving other SH2 carrying molecules. We demonstrated that SAP protein is expressed in activated T and NK, but not in activated B cells. This finding is in line with the fact that in vitro performance of effector cells derived from XLP patients is impaired. However, it is still not known why the severe symptoms (fatal mononucleosis or malignant lymphoproliferation in the survivors of the primary infection) are elicited by EBV. We studied SAP expression in several Burkitt lymphoma (BL) derived lines. In contrast to normal B cells, certain lines expressed SAP. These were all type I cells in the Burkitt line nomenclature: they expressed only one of the EBV encoded proteins (EBNA-1) and their phenotype corresponded to resting B cells. Lymphoblastoid cell lines and type III BLs, whose phenotype resembled activated B cells and expressed all nine EBV encoded proteins, were devoid of SAP. The relationship between cell activation and SAP expression is reciprocal in T and B cells i.e. BL lines, activated T and NK cells express SAP, while BL blasts do not express SAP. This opposite relationship may be exploited for studies about the function of SAP.
Collapse
Affiliation(s)
- Noémi Nagy
- Microbiology and Tumorbiology Center (MTC), Karolinska Institute, Stockholm, Sweden.
| | | | | | | | | | | |
Collapse
|
7
|
Beer S, Simins AB, Schuster A, Holzmann B. Molecular cloning and characterization of a novel SH3 protein (SLY) preferentially expressed in lymphoid cells. BIOCHIMICA ET BIOPHYSICA ACTA 2001; 1520:89-93. [PMID: 11470164 DOI: 10.1016/s0167-4781(01)00242-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A novel full-length cDNA was isolated from a murine T-cell lymphoma library that has an open reading frame encoding 381 amino acids. The predicted protein (termed SLY) contains a Src homology 3 domain and a sterile alpha motif, suggesting that it functions as a signaling adaptor protein in lymphocytes. Northern blot and in situ hybridization analysis showed a preferential expression in lymphoid tissues. The sly gene is located on the X-chromosome in close proximity to genes involved in various immune disorders. This is consistent with an additional role of SLY in immune pathology.
Collapse
Affiliation(s)
- S Beer
- Institute of Medical Microbiology, immunology and Hygiene, Technische Universität München, Munich, Germany.
| | | | | | | |
Collapse
|
8
|
Wu C, Nguyen KB, Pien GC, Wang N, Gullo C, Howie D, Sosa MR, Edwards MJ, Borrow P, Satoskar AR, Sharpe AH, Biron CA, Terhorst C. SAP controls T cell responses to virus and terminal differentiation of TH2 cells. Nat Immunol 2001; 2:410-4. [PMID: 11323694 DOI: 10.1038/87713] [Citation(s) in RCA: 157] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
SH2D1A, which encodes signaling lymphocyte activation molecule (SLAM)-associated protein (SAP), is altered in patients with X-linked lymphoproliferative disease (XLP), a primary immunodeficiency. SAP-deficient mice infected with lymphocytic choriomeningitis virus had greatly increased numbers of CD8+ and CD4+ interferon-gamma-producing spleen and liver cells compared to wild-type mice. The immune responses of SAP-deficient mice to infection with Leishmania major together with in vitro studies showed that activated SAP-deficient T cells had an impaired ability to differentiate into T helper 2 cells. The aberrant immune responses in SAP-deficient mice show that SAP controls several distinct key T cell signal transduction pathways, which explains in part the complexity of the XLP phenotypes.
Collapse
Affiliation(s)
- C Wu
- Division of Immunology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Sayós J, Nguyen KB, Wu C, Stepp SE, Howie D, Schatzle JD, Kumar V, Biron CA, Terhorst C. Potential pathways for regulation of NK and T cell responses: differential X-linked lymphoproliferative syndrome gene product SAP interactions with SLAM and 2B4. Int Immunol 2000; 12:1749-57. [PMID: 11099315 DOI: 10.1093/intimm/12.12.1749] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
SAP, the gene that is altered or absent in the X-linked lymphoproliferative syndrome (XLP), encodes a small protein that comprises a single SH2 domain and binds to the cell-surface protein SLAM which is present on activated or memory T and B cells. Because defective NK cell activity also has been reported in XLP patients, we studied the SAP gene in NK cells. SAP was induced upon viral infection of SCID mice and shown to be expressed in NK cells by in vitro culturing in the presence of IL-2. Moreover, SAP was expressed in the NK cell lines YT and RNK 16. Because SLAM, the cell-surface protein with which SAP interacts, and 2B4, a membrane protein having sequence homologies with SLAM, also were found to be expressed on the surfaces of activated NK and T cell populations, they may access SAP functions in these populations. Whereas we found that 2B4 also binds SAP, 2B4-SAP interactions occurred only upon tyrosine phosphorylation of 2B4. By contrast, SLAM-SAP interactions were independent of phosphorylation of Y281 and Y327 on SLAM. As CD48, the ligand for 2B4, is expressed on the surface of Epstein-Barr virus (EBV)-infected B cells, it is likely that SAP regulates signal transduction through this pair of cell-surface molecules. These data support the hypothesis that XLP is a result of both defective NK and T lymphocyte responses to EBV. The altered responses may be due to aberrant control of the signaling cascades which are initiated by the SLAM-SLAM and 2B4-CD48 interactions.
Collapse
Affiliation(s)
- J Sayós
- Division of Immunology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Nagy N, Cerboni C, Mattsson K, Maeda A, Gogolák P, Sümegi J, Lányi Á, Székely L, Carbone E, Klein G, Klein E. SH2D1A and slam protein expression in human lymphocytes and derived cell lines. Int J Cancer 2000. [DOI: 10.1002/1097-0215(20001101)88:3<439::aid-ijc17>3.0.co;2-#] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Noémi Nagy
- Microbiology and Tumorbiology Center (MTC), Karolinska Institute, Stockholm, Sweden
| | - Cristina Cerboni
- Microbiology and Tumorbiology Center (MTC), Karolinska Institute, Stockholm, Sweden
| | - Karin Mattsson
- Microbiology and Tumorbiology Center (MTC), Karolinska Institute, Stockholm, Sweden
| | - Akihiko Maeda
- Microbiology and Tumorbiology Center (MTC), Karolinska Institute, Stockholm, Sweden
| | - Péter Gogolák
- Microbiology and Tumorbiology Center (MTC), Karolinska Institute, Stockholm, Sweden
| | - János Sümegi
- Department of Pathology and Microbiology, Nebraska Medical Center, Omaha, Nebraska, USA
| | - Árpád Lányi
- Department of Pathology and Microbiology, Nebraska Medical Center, Omaha, Nebraska, USA
| | - László Székely
- Microbiology and Tumorbiology Center (MTC), Karolinska Institute, Stockholm, Sweden
| | - Ennio Carbone
- Microbiology and Tumorbiology Center (MTC), Karolinska Institute, Stockholm, Sweden
| | - George Klein
- Microbiology and Tumorbiology Center (MTC), Karolinska Institute, Stockholm, Sweden
| | - Eva Klein
- Microbiology and Tumorbiology Center (MTC), Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
11
|
Abstract
Infectious mononucleosis caused by Epstein-Barr virus (EBV) usually resolves over a period of weeks or months without sequelae but may occasionally be complicated by a wide variety of neurologic, hematologic, hepatic, respiratory, and psychological complications. The strength of association of EBV with many of these complications remains based on scattered case reports, often using unsophisticated diagnostic tests, and the evidence for causation in many instances is unconvincing. There is little benefit of antiviral treatment of uncomplicated or complicated infectious mononucleosis. Corticosteroids may have a role in hastening resolution of some complications, especially upper airway obstruction and possibly immune-mediated anemia and thrombocytopenia, but should be used judiciously.
Collapse
Affiliation(s)
- H B Jenson
- Department of Pediatrics, and Microbiology, University of Texas Health Science Center, San Antonio 78229-3900, USA.
| |
Collapse
|
12
|
Affiliation(s)
- A M Denman
- Northwick Park and St Mark's NHS Trust, Harrow, Middlesex, UK
| |
Collapse
|