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Madani A, Almutairi HM, Alshathry YH, Albinhar T, Barakeh MM. Sneddon Syndrome: A Case Report From Saudi Arabia. Cureus 2024; 16:e55509. [PMID: 38571838 PMCID: PMC10990651 DOI: 10.7759/cureus.55509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/05/2024] Open
Abstract
Sneddon syndrome, also known as livedo reticularis with cerebrovascular accidents, is a rare but chronic condition that affects blood vessels in the skin and brain. This syndrome is characterized by a net-like appearance on the skin, known as livedo reticularis, which occurs due to the constriction of blood vessels. In addition to skin manifestations, Sneddon syndrome is often associated with repeated neurological events, such as strokes or transient ischemic attacks. These neurological symptoms can vary in severity and can lead to various complications. Upon admission to the stroke unit, a 28-year-old female was found to have bilateral livedo reticularis affecting the soles and the dorsal sides of the hands. Patient evaluation is done through medical history, physical examination, routine laboratory tests, and other diagnostic procedures.
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Affiliation(s)
| | - Hanadi M Almutairi
- Department of Dermatology, King Saud University Medical City, Riyadh, SAU
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2
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Andriyashkina DY, Kondrashov AA, Shostak NА, Demidova NA, Yudin DV, Kulakov DY, Avetisian GR. Sneddon syndrome: A rare diagnosis. RHEUMATOLOGY SCIENCE AND PRACTICE 2022. [DOI: 10.47360/1995-4484-2022-630-637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The study objective is to demonstrate a rare cause of recurrent acute cerebrovascular diseases in a young patient – Sneddon syndrome. The patient revealed gene polymorphism: homozygous 4G/5G in the plasminogen activator inhibitor-1 (PAI-1) gene, C807T in the glycoprotein I gene (GPIa), T1565C in the glycoprotein III gene (GPIIIa), G1639A in the vitamin K epoxide reductase gene (VKORC1), increased homocysteine, which were risk factors for thrombosis.
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Affiliation(s)
| | | | - N. А. Shostak
- N.I. Pirogov Russian National Research Medical University
| | - N. A. Demidova
- N.I. Pirogov Russian National Research Medical University
| | - D. V. Yudin
- N.I. Pirogov Russian National Research Medical University
| | - D. Yu. Kulakov
- N.I. Pirogov Russian National Research Medical University
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3
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Primary angiitis of central nervous system – A challenging diagnosis. J Neuroimmunol 2022; 366:577844. [DOI: 10.1016/j.jneuroim.2022.577844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/26/2022] [Accepted: 03/06/2022] [Indexed: 12/14/2022]
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4
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Greisenegger EK, Llufriu S, Chamorro A, Cervera A, Jimenez-Escrig A, Rappersberger K, Marik W, Greisenegger S, Stögmann E, Kopp T, Strom TM, Henes J, Joutel A, Zimprich A. A NOTCH3 homozygous nonsense mutation in familial Sneddon syndrome with pediatric stroke. J Neurol 2020; 268:810-816. [PMID: 32980981 PMCID: PMC7914241 DOI: 10.1007/s00415-020-10081-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/05/2020] [Accepted: 07/13/2020] [Indexed: 11/25/2022]
Abstract
Sneddon syndrome is a rare disorder affecting small and medium-sized blood vessels that is characterized by the association of livedo reticularis and stroke. We performed whole-exome sequencing (WES) in 2 affected siblings of a consanguineous family with childhood-onset stroke and identified a homozygous nonsense mutation within the epidermal growth factor repeat (EGFr) 19 of NOTCH3, p.(Arg735Ter). WES of 6 additional cases with adult-onset stroke revealed 2 patients carrying heterozygous loss-of-function variants in putative NOTCH3 downstream genes, ANGPTL4, and PALLD. Our findings suggest that impaired NOTCH3 signaling is one underlying disease mechanism and that bi-allelic loss-of-function mutation in NOTCH3 is a cause of familial Sneddon syndrome with pediatric stroke.
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Affiliation(s)
- Elli Katharine Greisenegger
- Department of Dermatology and Venereology, University Hospital of St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sara Llufriu
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Hospital Clinic Barcelona, IDIBAPS and Universitat de Barcelona, Barcelona, Spain
| | - Angel Chamorro
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic Barcelona, Barcelona, Spain
- Institure Investigacions Biomèdicas August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Wolfgang Marik
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Greisenegger
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Elisabeth Stögmann
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Tamara Kopp
- Juvenis Medical Center, 1010, Vienna, Austria
| | - Tim M Strom
- Institute of Human Genetics, Technical University Munich, Munich, Germany
- Department of Internal Medicine II (Hematology, Oncology, Rheumatology and Clinical Immunology), Centre for Interdisciplinary Clinical Rheumatology and Immunology, Eberhard Karls-University Tuebingen, Tübingen, Germany
| | - Jörg Henes
- Department of Internal Medicine II (Hematology, Oncology, Rheumatology and Clinical Immunology), Centre for Interdisciplinary Clinical Rheumatology and Immunology, Eberhard Karls-University Tuebingen, Tübingen, Germany
| | - Anne Joutel
- Institute of Psychiatry and Neurosciences of Paris, INSERM UMR1266, University of Paris, 75014, Paris, France
| | - Alexander Zimprich
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Cho TA, Jones A. CNS vasculopathies: Challenging mimickers of primary angiitis of the central nervous system. Best Pract Res Clin Rheumatol 2020; 34:101569. [PMID: 32859518 DOI: 10.1016/j.berh.2020.101569] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Primary angiitis of the central nervous system (CNS) is an inflammatory vasculopathy affecting the brain and spinal cord. It is a difficult diagnosis to make because of its insidious nonspecific course and its multiple mimics. This review identifies and discusses some noninfectious mimickers of primary CNS angiitis, including: reversible cerebral vasoconstriction syndrome, Sneddon's Syndrome, amyloid-beta-related angiopathy, Susac Syndrome, and neurosarcoidosis. Each condition will be reviewed in terms of epidemiology, pathology, clinical presentation, diagnostic approach, and treatment. Distinguishing these mimics from the primary angiitis of the CNS is important for proper treatment and prognosis.
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Affiliation(s)
| | - Ann Jones
- 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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Fiore A, Ternacle J, Piscitelli M, Fardet L, Mongardon N. Sneddon syndrome: anaesthetic and surgical challenges in cardiac valve surgery. Perfusion 2020; 35:710-711. [PMID: 31957552 DOI: 10.1177/0267659119899333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Antonio Fiore
- Department of Cardiac and Thoracic Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.,SOS-Endocardites Unit, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Julien Ternacle
- SOS-Endocardites Unit, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.,Department of Cardiology, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Mariantonietta Piscitelli
- Department of Cardiac and Thoracic Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Laurence Fardet
- Department of Dermatology, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Nicolas Mongardon
- SOS-Endocardites Unit, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.,Department of Anesthesiology and Critical Care Medicine, Hôpitaux Universitaires Henri Mondor, Université Paris Est Créteil, Assistance Publique-Hôpitaux de Paris, Créteil, France
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Samanta D, Cobb S, Arya K. Sneddon Syndrome: A Comprehensive Overview. J Stroke Cerebrovasc Dis 2019; 28:2098-2108. [PMID: 31160219 DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/08/2019] [Accepted: 05/14/2019] [Indexed: 11/17/2022] Open
Abstract
Sneddon syndrome (SS) is an episodic or chronic, slowly progressive disorder and characterized by generalized livedo racemosa (patchy, violaceous, skin discoloration) and recurrent cerebrovascular events. The histopathology of skin and brain is remarkable for a noninflammatory thrombotic vasculopathy involving medium- and small-sized dermal and cerebral arteries, respectively. Approximately 80% of the SS patients are women with a median age of diagnosis at 40 years. However, the onset of the disease during childhood have been reported. Etiopathogenesis of SS is unknown with 2 primary mechanisms proposed - autoimmune/inflammatory versus thrombophilia. SS is primarily classified as antiphospholipid positive or negative type. Neurological manifestations usually occur in 3 phases: (1) prodromal symptoms such as headaches, dizziness, and vertigo, (2) recurrent strokes, and (3) early onset dementia. Livedo racemosa precedes the onset of recurrent strokes by more than 10 years, but in many instances, the significance of the skin lesion is recognized only after the appearance of the stroke. The involvement of the heart valves, systolic labile hypertension, and retinal changes are also commonly associated with this syndrome. Treatment of SS is primarily based on anecdotal reports. Antiplatelet and antithrombotic agents are used for secondary stroke prophylaxis, and a recent study showed a relatively lower stroke recurrence rate with the universal use of antiplatelet/antithrombotic agents. Routine use of anti-inflammatory or immunosuppressive therapies is controversial. Neuropsychiatric prognosis of SS is relatively poor with predominant deficits in the concentration, attention, visual perception, and visuospatial skills.
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Affiliation(s)
- Debopam Samanta
- Neurology Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Sarah Cobb
- Neurology Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kapil Arya
- Neurology Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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9
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Abstract
Sneddon's syndrome refers to the enigmatic association of ischaemic stroke and livedo reticularis. We review the Sneddon's syndrome literature examining the association of this condition with headache, including migraine. Case reports and series are stratified into two groups based on headache reference. In the group without a reference to headache, there are 208 persons, with a female to male ratio of 3 : 1. In the headache reference group, there are 175 persons, with a female to male ratio of 3.5 : 1. The proportion with headache in this second group is 58% (102 individuals), with headache described as migraine in 28 (27.5%) of the headache subjects, including six with migraine with aura. The frequency of headache is not significantly higher in persons with positive anti-phospholipid antibodies compared with the negative cohort (43% vs. 32%, P = 0.07). A review of the histopathological, radiological and serological data in Sneddon's syndrome and migraine underscores the plausibility of an association. Considered in the context of increased risk of stroke with migraine, a higher frequency of livedo in migraineurs with stroke, and the association of migraine and livedo reticularis, the question of whether livedo reticularis may be a risk marker for stroke in migraineurs is an area for further study.
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Affiliation(s)
- G E Tietjen
- Department of Neurology, Medical University of Ohio, Toledo, OH 43614, USA.
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Wu S, Xu Z, Liang H. Sneddon's syndrome: a comprehensive review of the literature. Orphanet J Rare Dis 2014; 9:215. [PMID: 25551694 PMCID: PMC4302600 DOI: 10.1186/s13023-014-0215-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 12/12/2014] [Indexed: 11/10/2022] Open
Abstract
Sneddon's syndrome (SS) is a rare non-inflammatory thrombotic vasculopathy characterized by the combination of cerebrovascular disease with livedo racemosa(LR). The Orpha number for SS is ORPHA820. It has been estimated that the incidence of SS is 4 per 1 million per annum in general population and generally occurs in women between the ages of 20 and 42 years. LR may precede the onset of stroke by years and the trunk and/or buttocks are involved in nearly all patients. The cerebrovascular manifestations are mostly secondary to ischemia (transient ischemic attacks and cerebral infarct). Other neurological symptoms range from headache, cerebral hemorrhage, seizures, cognitive and psychiatric disturbances. The involved internal organs include heart, kidney, and eyes. Histological findings of skin are characteristic and the involved vessels are small to medium-sized arteries at the border of dermis to subcutis with a distinct histopathological time course. The main diagnostic criteria are general LR with typical histopathological findings on skin biopsy and focal neurological deficits. The pathogenesis is related to hypercoagulable state and intrinsic small-vessel vasculopathy. The optimal management remains an unsolved problem and long-term anticoagulation have been recommended for cerebral ischemic events based on the presumed pathogenesis. There are controversial results in treatment of SS with immunomodulatory agents. The aim of this review is to comprehensively discuss this disease.
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Affiliation(s)
- Shengjun Wu
- Department of cardiothoracic surgery, The First Affiliated Hospital, School of Medicine, ZheJiang University, ZheJiang, China.
| | - Ziqi Xu
- Department of Neurology, The First Affiliated Hospital, School of Medicine, ZheJiang University, qingchun road 79, Hangzhou, ZheJiang, China, 310003.
| | - Hui Liang
- Department of Neurology, The First Affiliated Hospital, School of Medicine, ZheJiang University, qingchun road 79, Hangzhou, ZheJiang, China, 310003.
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Hannon PM, Kuo SH, Strutt AM, York MK, Kass JS. Improvement of neurological symptoms and memory and emotional status in a case of seronegative Sneddon syndrome with cyclophosphamide. Clin Neurol Neurosurg 2010; 112:544-7. [PMID: 20444540 DOI: 10.1016/j.clineuro.2010.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 03/31/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022]
Abstract
Sneddon syndrome (SS) is characterized by livedo racemosa, recurrent ischemic strokes, and often progressive vascular dementia. Treatment options for SS center on either anticoagulation or immunosuppression to prevent strokes and to dissipate the skin findings, with these modalities based historically on the presence or absence of antiphospholipid antibodies (APA) respectively. However, few effective treatments have been reported to reverse the cognitive decline in SS. We report a case of a woman with seronegative SS (absence of APA) with cognitive decline who demonstrated objective and subjective improvements in her memory and emotional functioning after treatment with cyclophosphamide.
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Affiliation(s)
- Peter M Hannon
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, United States
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Ulukaya S, Makay O, Icoz G, Demir F, Sezer T. Perioperative management of Sneddon syndrome during thyroidectomy. J Clin Anesth 2008; 20:458-61. [PMID: 18929289 DOI: 10.1016/j.jclinane.2008.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 03/06/2008] [Accepted: 03/20/2008] [Indexed: 11/26/2022]
Abstract
The perioperative management of an adult woman with Sneddon syndrome is presented. This syndrome is characterized by vasculopathy, hypercoagulable state, ischemic cerebral events, livedo reticularis, heart valve disease, and renal insufficiency. During surgery in these patients, the balance between bleeding and thrombosis requires rapid diagnostic information for therapeutic decisions. Thrombelastographic analysis may be a valuable tool to use in monitoring these patients.
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Affiliation(s)
- Sezgin Ulukaya
- Department of Anesthesia and Reanimation, Ege University School of Medicine, Izmir, Turkey
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Marinho JL, Piovesan EJ, Leite Neto MP, Kotze LR, Noronha LD, Twardowschy CA, Lange MC, Scola RH, Zétola VHF, Nóvak EM, Werneck LC. Clinical, neurovascular and neuropathological features in Sneddon's syndrome. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 65:390-5. [PMID: 17665002 DOI: 10.1590/s0004-282x2007000300005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Accepted: 02/06/2007] [Indexed: 11/21/2022]
Abstract
Sneddon's syndrome (SS) is characterized by ischemic cerebrovascular episodes and livedo reticularis. It is more common in young women and can also be associated with valvulopathy, a history of spontaneous abortion, renal involvement and vascular dementia. We describe three cases of young women with this disease. The patients had repeated ischemic cerebral episodes, livedo reticularis and thrombocytopenia. CT and MRI showed strokes and cerebral atrophy. Autopsy in one of the patients revealed cerebral infarctions. Anticardiolipin antibodies were detected in two patients. Antiphospholipid antibodies may be found in some patients with ischemic cerebrovascular events and livedo reticularis. SS may thus be associated with antiphospholipid syndrome. We described three new cases of SS and discuss the pathophysiology of this disease.
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Abstract
The occurrence of systemic lupus erythematosus (SLE) in several members of a family has spurred intense efforts to identify susceptibility genes predisposing to the disease. As a result, a number of candidate association genes in different ethnic groups have been identified, and some genes have been linked to specific lupus manifestations. Particularly where familial disease occurs in childhood, and especially when it occurs prior to puberty, complement deficiencies and other immunologic defects should be explored. Evidence of other forms of autoimmunity, including autoimmune thyroiditis and antiphospholipid syndrome (APS), is common in families with SLE. Familial APS is uncommon in the absence of other thrombophilic defects, but occasionally is seen with apparent autosomal dominant inheritance. Thus far, no firm gene associations have been identified for APS, in part because of the rarity of multiplex families to study. A search for other familial causes of thrombotic disease should be performed when APS occurs in more than one family member.
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Affiliation(s)
- Al Sestak
- Oklahoma Medical Research Foundation, Oklahoma City, USA
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Lousa M, Pardo A, Arnaiz-Villena A, Jimenez-Escrig A, Gobernado J. Histocompatibility class I and II antigens in extensive kindred with Sneddon's syndrome and related hypercoagulation disorders. Hum Immunol 2006; 68:26-9. [PMID: 17207709 DOI: 10.1016/j.humimm.2006.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 10/05/2006] [Accepted: 10/13/2006] [Indexed: 10/23/2022]
Abstract
We have studied the relationship between the histocompatibility class I and II antigens and Sneddon's syndrome (SS) in a Spanish patient with SS and her relatives (13 available members of an extensive 3-generation pedigree with diverse autoimmune hypercoagulation abnormalities). The patient and her father were diagnosed with a primary antiphospholipid antibody syndrome and were HLA-A30-B13-Bw6. In addition, a HLA-Bw6-DQ1 association was present in all the members of this kindred. These data suggest that the combination of the histocompatibility class I and II antigens in this family may be a marker for predisposition to SS.
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Affiliation(s)
- Manuel Lousa
- S. de Neurología, Hospital Insular, Las Palmas, Spain
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