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Gernez Y, Narula M, Cepika AM, Valdes Camacho J, Hoyte EG, Mouradian K, Glader B, Singh D, Sathi B, Rao L, Tolin AL, Weinberg KI, Lewis DB, Bacchetta R, Weinacht KG. Case report: Refractory Evans syndrome in two patients with spondyloenchondrodysplasia with immune dysregulation treated successfully with JAK1/JAK2 inhibition. Front Immunol 2024; 14:1328005. [PMID: 38347954 PMCID: PMC10859398 DOI: 10.3389/fimmu.2023.1328005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/28/2023] [Indexed: 02/15/2024] Open
Abstract
Biallelic mutations in the ACP5 gene cause spondyloenchondrodysplasia with immune dysregulation (SPENCDI). SPENCDI is characterized by the phenotypic triad of skeletal dysplasia, innate and adaptive immune dysfunction, and variable neurologic findings ranging from asymptomatic brain calcifications to severe developmental delay with spasticity. Immune dysregulation in SPENCDI is often refractory to standard immunosuppressive treatments. Here, we present the cases of two patients with SPENCDI and recalcitrant autoimmune cytopenias who demonstrated a favorable clinical response to targeted JAK inhibition over a period of more than 3 years. One of the patients exhibited steadily rising IgG levels and a bone marrow biopsy revealed smoldering multiple myeloma. A review of the literature uncovered that approximately half of the SPENCDI patients reported to date exhibited increased IgG levels. Screening for multiple myeloma in SPENCDI patients with rising IgG levels should therefore be considered.
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Affiliation(s)
- Yael Gernez
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Mansi Narula
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Alma-Martina Cepika
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Juanita Valdes Camacho
- Division of Allergy and Immunology, Department of Pediatrics, Louisiana State University (LSU) Health, Shreveport, LA, United States
| | - Elisabeth G. Hoyte
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Kirsten Mouradian
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Bertil Glader
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Deepika Singh
- Division of Rheumatology, Department of Pediatrics, Valley Children Hospital, Madera, CA, United States
| | - Bindu Sathi
- Division of Hematology, Department of Pediatrics, Valley Children Hospital, Madera, CA, United States
| | - Latha Rao
- Division of Hematology, Department of Pediatrics, Valley Children Hospital, Madera, CA, United States
| | - Ana L. Tolin
- Division of Immunology, Department of Pediatrics, Hospital Pediatrico Dr. Humberto Notti, Mendoza, Argentina
| | - Kenneth I. Weinberg
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - David B. Lewis
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Rosa Bacchetta
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Katja G. Weinacht
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
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Polat R, Özdemir Ö. Spondyloenchondrodysplasia Due to Mutation in ACP5 Gene Presenting
with Nephrotic Syndrome: A Case Report. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1806-0918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AbstractSpondyloenchondrodysplasia (SPENCD) with immune dysregulation (SPENCDI) is a rare
autosomal recessive inherited immuno-osseous dysplasia characterized by
spondylo-metaphyseal enchondromas, along with immune dysregulation ranging from
immunodeficiency to autoimmune disorder. Here, we present two cousins with
ACP5 gene mutation who had severe short stature with mild
hypogammaglobulinemia, nephrotic syndrome, autoimmune thyroiditis and cerebral
calcification (Case 1); and in the other (Case 2), there was no clinical
findings other than severe short stature, CD4+−T cell
lymphopenia and non-autoimmune compensated hypothyroidism. We wanted to
emphasize that monogenic causes should be considered in the etiology of
early-onset nephrotic syndrome due to the detection of a mutation in the
ACP5 gene (her actual diagnosis was changed to SPENCDI.) 5 years
after the diagnosis of nephrotic syndrome in the first case, and that the renal
involvement may occur without SLE in patients with ACP5 mutation. Severe
short stature was a common finding in both cases. We underlined that the clinic
can be different even in the same mutation, due to the absence of cerebral
calcification and renal involvement in the second case, which is a cousin with
Case 1. As a result, endocrinologists, immunologists, rheumatologists,
nephrologists and orthopedists should be aware of this syndrome, because SPENCDI
causes a pleiotropic (due to more than one phenotypic effect of a gene) clinical
picture. Severe short stature may be the only presenting sign of patients with
SPENCDI. In addition, in the presence of early-onset nephrotic syndrome and
autoimmune thyroiditis, the patient should be evaluated for this type of
monogenic disorders as well.
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Affiliation(s)
- Recep Polat
- Department of Pediatric Endocrinology, Sakarya Training and Research
Hospital, Sakarya, Turkey
- Division of Allergy and Immunology, Department of Pediatrics, Sakarya
Training and Research Hospital, Sakarya, Turkey
| | - Öner Özdemir
- Division of Allergy and Immunology, Department of Pediatrics, Sakarya
Training and Research Hospital, Sakarya, Turkey
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