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Valente C, Caldeira MB, Duarte B, Batista J, Cordeiro AI. Unilateral segmental presentation and a novel EPHB4 gene variant in capillary malformation-arteriovenous malformation type 2. Pediatr Dermatol 2024; 41:344-345. [PMID: 38092051 DOI: 10.1111/pde.15493] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/28/2023] [Indexed: 03/19/2024]
Abstract
Capillary malformation-arteriovenous malformation is a rare autosomal dominant disorder associated with EPHB4 loss-of-function mutations. We report the unique presentation of a 6-year-old girl with multiple capillary malformations in a unilateral segmental distribution affecting the right hemiface, right upper chest, and right arm associated with overgrowth. Targeted next-generation sequencing on a tissue sample revealed a novel heterozygotic variant in the EPHB4 gene (NM_004444.5 (EPHB4): c.715T>A, p.[Cys239Ser]). This case highlights a distinct presentation of CM-AVM type 2 and showcases a new variant in EPHB4 not previously reported in the literature.
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Affiliation(s)
- C Valente
- Dermatology and Venereology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - M B Caldeira
- Dermatology and Venereology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - B Duarte
- Dermatology and Venereology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - J Batista
- Dermatology and Venereology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - A I Cordeiro
- Primary Immunodeficiencies Unit, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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2
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Rebelo M, Francisco T, Perry da Câmara R, Pereira A, Iraneta A, Amorim M, Paiva Lopes MJ, Lopes da Silva R, Cordeiro AI. Multidisciplinary Outpatient Clinic of Neurocutaneous Diseases: Five-year Experience of a Pediatric Tertiary Hospital in Portugal. ACTA MEDICA PORT 2024; 37:187-197. [PMID: 37294265 DOI: 10.20344/amp.19063] [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: 09/11/2022] [Accepted: 03/13/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Neurocutaneous syndromes (NCS) are a heterogeneous group of conditions with multiorgan involvement and diverse manifestations, evolving throughout life with significant morbidity. A multidisciplinary approach to NCS patients has been advocated, although a specific model is not yet established. The aim of this study was 1) to describe the organization of the recently created Multidisciplinary Outpatient Clinic of Neurocutaneous Diseases (MOCND) at a Portuguese pediatric tertiary hospital; 2) to share our institutional experience focusing on the most common conditions, neurofibromatosis type 1 (NF1) and tuberous sclerosis complex (TSC); 3) to analyze the advantages of a multidisciplinary center and approach in NCS. METHODS Retrospective analysis of 281 patients enrolled in the MOCND over the first five years of activity (October 2016 to December 2021), reviewing genetics, family history, clinical features, complications, and therapeutic strategies for NF1 and TSC. RESULTS The clinic works weekly with a core team of pediatricians and pediatric neurologists supported by other specialties as needed. Of the 281 patients enrolled, 224 (79.7%) had identifiable syndromes such as NF1 (n = 105), TSC (n = 35), hypomelanosis of Ito (n = 11), Sturge-Weber syndrome (n = 5), and others. In NF1 patients, 41.0% had a positive family history, all manifested café-au-lait macules, 38.1% neurofibromas with 45.0% being large plexiform neurofibromas. Sixteen were under treatment with selumetinib. Genetic testing was performed in 82.9% of TSC patients with pathogenic variants found in TSC2 gene in 72.4% patients (82.7% if considered contiguous gene syndrome). Family history was positive in 31.4%. All TSC patients presented hypomelanotic macules and fulfilled diagnostic criteria. Fourteen patients were being treated with mTOR inhibitors. CONCLUSION Offering a systematic and multidisciplinary approach to NCS patients enables timely diagnosis, promotes a structured follow-up, and encourages discussion to outline management plans for optimal care to every patient, with significant impact on the quality of life of patients and families.
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Affiliation(s)
- Mafalda Rebelo
- Pediatrics Department. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisbon. Portugal
| | - Telma Francisco
- Multidisciplinary Outpatient Clinic of Neurocutaneous Diseases. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisbon; Nephrology Department. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisbon. Portugal
| | - Rosário Perry da Câmara
- Multidisciplinary Outpatient Clinic of Neurocutaneous Diseases. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisbon; Pediatric Neurology Department. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisbon. Portugal
| | - Andreia Pereira
- Multidisciplinary Outpatient Clinic of Neurocutaneous Diseases. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisbon; Pediatric Neurology Department. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisbon. Portugal
| | - Amets Iraneta
- Multidisciplinary Outpatient Clinic of Neurocutaneous Diseases. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisbon; Neurosurgery Department. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisbon. Portugal
| | - Marta Amorim
- Multidisciplinary Outpatient Clinic of Neurocutaneous Diseases. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisbon; Genetics Department. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisbon. Portugal
| | - Maria João Paiva Lopes
- Dermatology Department. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisbon; Centro de Estudos de Doenças Crónicas - CEDOC. NOVA Medical School. Universidade NOVA de Lisboa. Lisbon. Portugal
| | - Rita Lopes da Silva
- Multidisciplinary Outpatient Clinic of Neurocutaneous Diseases. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisbon; Pediatric Neurology Department. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisbon. Portugal
| | - Ana Isabel Cordeiro
- Multidisciplinary Outpatient Clinic of Neurocutaneous Diseases. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisbon; Pediatric Neurology Department. Hospital Dona Estefânia. Centro Hospitalar Universitário de Lisboa Central. Lisbon. Portugal
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3
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João AL, Cunha N, Cordeiro AI, Lopes MJP. [Artículo traducido] Síndrome de Van der Woude y alopecia areata: más que una asociación fortuita? Actas Dermosifiliogr 2023; 114:T921-T922. [PMID: 37748732 DOI: 10.1016/j.ad.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/20/2022] [Accepted: 07/06/2022] [Indexed: 09/27/2023] Open
Affiliation(s)
- A L João
- Dermatology Department, Centro Hospitalar Universitário de Lisboa Central - Lisboa, Portugal.
| | - N Cunha
- Dermatology Department, Centro Hospitalar Universitário de Lisboa Central - Lisboa, Portugal
| | - A I Cordeiro
- Pediatrics Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - M J Paiva Lopes
- Dermatology Department, Centro Hospitalar Universitário de Lisboa Central - Lisboa, Portugal
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4
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João AL, Cunha N, Cordeiro AI, Paiva Lopes MJ. Van der Woude Syndrome and Alopecia Areata: More Than a Fortuitous Association? Actas Dermosifiliogr 2023; 114:921-922. [PMID: 36740176 DOI: 10.1016/j.ad.2022.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/20/2022] [Accepted: 07/06/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- A L João
- Dermatology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
| | - N Cunha
- Dermatology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - A I Cordeiro
- Pediatrics Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - M J Paiva Lopes
- Dermatology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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5
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Hormigo I, Valente Pinto M, Cordeiro AI, Henriques C, Martins C, Parente Freixo J, Conde M, Gouveia C, Farela Neves J. Hemophagocytic lymphohistiocytosis in an adolescent with NLRP12-related autoinflammatory disorder-A case report. Pediatr Allergy Immunol 2023; 34:e14020. [PMID: 37747755 DOI: 10.1111/pai.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/06/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Inês Hormigo
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central EPE, Lisbon, Portugal
| | - Marta Valente Pinto
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central EPE, Lisbon, Portugal
- Centro de investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Caparica, Portugal
| | - Ana Isabel Cordeiro
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central EPE, Lisbon, Portugal
| | - Cristina Henriques
- Pediatric Reumatology Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central EPE, Lisbon, Portugal
| | - Catarina Martins
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
- Immunology Department, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - João Parente Freixo
- Centro de Genética Preditiva e preventiva, Instituto de Biologia Molecular e Celular, Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Marta Conde
- Pediatric Reumatology Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central EPE, Lisbon, Portugal
- Auto-inflammatory syndromes Clinics, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central EPE, Lisbon, Portugal
| | - Catarina Gouveia
- Pediatric Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central EPE, Lisbon, Portugal
| | - João Farela Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central EPE, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
- Auto-inflammatory syndromes Clinics, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central EPE, Lisbon, Portugal
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Simão Raimundo D, Cordeiro AI, Parente Freixo J, Valente Pinto M, Neves C, Farela Neves J. Case Report: Patient with deficiency of ADA2 presenting leukocytoclastic vasculitis and pericarditis during infliximab treatment. Front Pediatr 2023; 11:1200401. [PMID: 37388286 PMCID: PMC10303984 DOI: 10.3389/fped.2023.1200401] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/15/2023] [Indexed: 07/01/2023] Open
Abstract
Deficiency of adenosine deaminase 2 (DADA2), first reported in 2014, is a disease with great phenotypic variability, which has been increasingly reported. Therapeutic response depends on the phenotype. We present a case of an adolescent with recurrent fever, oral aphthous ulcers, and lymphadenopathy from 8 to 12 years of age and subsequently presented with symptomatic neutropenia. After the diagnosis of DADA2, therapy with infliximab was started, but after the second dose, she developed leukocytoclastic vasculitis and showed symptoms of myopericarditis. Infliximab was switched to etanercept, with no relapses. Despite the safety of tumor necrosis factor alpha inhibitors (TNFi), paradoxical adverse effects have been increasingly reported. The differential diagnosis between disease new-onset manifestations of DADA2 and side effects of TNFi can be challenging and warrants further clarification.
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Affiliation(s)
- Diana Simão Raimundo
- Pediatrics Department, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - Ana Isabel Cordeiro
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - João Parente Freixo
- Centro de Genética Preditiva e Preventiva, Instituto de Biologia Molecular e Celular, Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Marta Valente Pinto
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM); Egas Moniz School of Health & Science, Caparica, Almada, Portugal
| | - Conceição Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - João Farela Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
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7
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Caseiro Alves ME, Cordeiro AI, Carvalho R, João A. Atypical presentation of erythema multiforme. BMJ Case Rep 2022; 15:15/7/e251076. [DOI: 10.1136/bcr-2022-251076] [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] [Indexed: 11/04/2022] Open
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8
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Castro ACE, Maia R, Batalha S, Freixo JP, Martins C, Neves C, Cordeiro AI, Neves JF. Case Report: Wide Spectrum of Manifestations of Ligase IV Deficiency: Report of 3 Cases. Front Immunol 2022; 13:869728. [PMID: 35592332 PMCID: PMC9111885 DOI: 10.3389/fimmu.2022.869728] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022] Open
Abstract
DNA ligase IV deficiency is a rare autosomal recessive disorder associated with impaired DNA repair mechanisms. Most patients with DNA repair defects present with neurologic deficits, combined immunodeficiency, bone marrow failure, and/or hematologic neoplasia. We present 3 unrelated cases of ligase IV deficiency with different clinical presentations. Patient 1 presented at the age of 5 with bone marrow failure, dysmorphic features, and T and B lymphopenia. A compound heterozygous variant L19W/K635fs in the LIG4 gene was identified. Patient 2 presented at the age of 16 with recurrent infections. He had agammaglobulinemia and absent B cells. A homozygous R278H in the LIG4 gene was identified. Patient 3 was referred for vitiligo and B-cell lymphopenia (low class-switched B cells) and hypogammaglobulinemia. Homozygous R278H in LIG4 was also identified. In the last few years, the spectrum of clinical manifestations caused by ligase IV deficiency has widened, making it very difficult to establish an accurate clinical diagnosis. The use of NGS allows a proper diagnosis and provides a better prognosis and adequate family counseling.
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Affiliation(s)
- Ana Costa E Castro
- Pediatrics, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - Raquel Maia
- Pediatric Hematology Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - Sara Batalha
- Pediatric Hematology Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisboa, Portugal
| | - João Parente Freixo
- Centro de Genética Preditiva e Preventiva, Instituto de Biologia Molecular e Celular, Instituto de Investigacão e Inovacaão em Saúde, Porto, Portugal
| | - Catarina Martins
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal.,Chronic Diseases Research Centre (CEDOC), NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Conceição Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Ana Isabel Cordeiro
- Chronic Diseases Research Centre (CEDOC), NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - João Farela Neves
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal.,Chronic Diseases Research Centre (CEDOC), NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal.,Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
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9
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Coelho PS, Gouveia C, Pinto MV, Neves C, Cordeiro AI, Neves JF. Recurrent pyogenic infections caused by a novel Gln1420* mutation in the C3 gene. Front Pediatr 2022; 10:1017195. [PMID: 36299691 PMCID: PMC9589888 DOI: 10.3389/fped.2022.1017195] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022] Open
Abstract
C3 is a crucial protein of the complement system. Congenital C3 deficiency is extremely rare and manifests through recurrent, severe infections and should always be considered as a differential diagnosis of recurrent pyogenic infections. We report a case of a patient with a novel C3 gene mutation, responsible for complete C3 deficiency with impaired complement system activation and recurrent infections.
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Affiliation(s)
- Pedro Simão Coelho
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, CHULC-EPE, Lisbon, Portugal
| | - Catarina Gouveia
- Infectious Disease Unit, Hospital Dona Estefânia, CHULC-EPE, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Marta Valente Pinto
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, CHULC-EPE, Lisbon, Portugal
| | - Conceição Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, CHULC-EPE, Lisbon, Portugal
| | - Ana Isabel Cordeiro
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, CHULC-EPE, Lisbon, Portugal
| | - João Farela Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, CHULC-EPE, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal.,Chronic Diseases Research Center (CEDOC), NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
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10
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Tsilifis C, Slatter M, Cordeiro AI, Hambleton S, Engelhardt KR, Griffin H, Gennery AR, Neves JF. Congenital nephrotic syndrome in IL7Rα-SCID: A rare feature of maternofetal graft-versus-host disease. J Allergy Clin Immunol Pract 2021; 9:4151-4153.e1. [PMID: 34153518 DOI: 10.1016/j.jaip.2021.05.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/20/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Christo Tsilifis
- Paediatric Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital (GNCH), Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Mary Slatter
- Paediatric Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital (GNCH), Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ana Isabel Cordeiro
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia - CHLC, EPE, Lisbon, Portugal
| | - Sophie Hambleton
- Paediatric Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital (GNCH), Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Karin R Engelhardt
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Helen Griffin
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew R Gennery
- Paediatric Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital (GNCH), Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - João Farela Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia - CHLC, EPE, Lisbon, Portugal; CEDOC, Chronic Diseases Research Center, NOVA Medical School, Lisbon, Portugal
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11
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Padeira GL, Araújo C, Cordeiro AI, Freixo J, Martins CG, Neves JF. Case Report: Primary Immunodeficiencies, Massive EBV+ T-Cell Lympoproliferation Leading to the Diagnosis of ICF2 Syndrome. Front Immunol 2021; 12:654167. [PMID: 33995370 PMCID: PMC8113761 DOI: 10.3389/fimmu.2021.654167] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/08/2021] [Indexed: 12/04/2022] Open
Abstract
In immunocompromised patients, EBV may elicit B-cell transformation and proliferation. A 5-year-old microcephalic boy was admitted with fever and non-malignant polymorphic T-cell lymphoproliferative disease associated with EBV. A presumptive diagnosis of primary immunodeficiency with inability to control EBV was made and next-generation sequencing led to the identification of a novel ZBTB24 mutation (ICF2-syndrome). This case shows that susceptibility to EBV seems to be particular of ICF-2 as it has not been described in the other types of ICF. It is mandatory to raise the hypothesis of an underlying PID in case of severe EBV infection.
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Affiliation(s)
- Gonçalo Luzes Padeira
- Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Catarina Araújo
- Departamento de Anatomia Patológica, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Isabel Cordeiro
- Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - João Freixo
- Centro de Genética Preditiva e Preventiva, Instituto de Biologia Molecular e Celular, Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Catarina Gregório Martins
- CEDOC, Chronic Diseases Research Center, NOVA Medical School, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - João Farela Neves
- Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,CEDOC, Chronic Diseases Research Center, NOVA Medical School, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
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12
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Marujo F, Pelham SJ, Freixo J, Cordeiro AI, Martins C, Casanova JL, Lei WT, Puel A, Neves JF. A Novel TRAF3IP2 Mutation Causing Chronic Mucocutaneous Candidiasis. J Clin Immunol 2021; 41:1376-1379. [PMID: 33825088 DOI: 10.1007/s10875-021-01026-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/15/2021] [Indexed: 12/26/2022]
Abstract
Inborn errors of the IL-17-mediated signaling have been associated with chronic mucocutaneous candidiasis (CMC). We describe a patient with CMC, atopic dermatitis, enamel dysplasia, and recurrent parotitis harboring a novel compound heterozygous mutation of TRAF3IP2, leading to autosomal recessive ACT1 deficiency and deficient IL-17 signaling.
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Affiliation(s)
- Filipa Marujo
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia-CHLC, EPE, Rua Jacinta Marto, 1169-045, Lisbon, Portugal.
| | - Simon J Pelham
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, 10065, USA
| | - João Freixo
- Centro de Genética Preditiva e Preventiva, Instituto de Biologia Molecular e Celular, Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Ana Isabel Cordeiro
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia-CHLC, EPE, Rua Jacinta Marto, 1169-045, Lisbon, Portugal
| | - Catarina Martins
- CEDOC, Chronic Diseases Research Center, NOVA Medical School, Lisbon, Portugal
| | - Jean-Laurent Casanova
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, 10065, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Necker Hospital for Sick Children, 75015, Paris, France
- Howard Hughes Medical Institute, New York, NY, USA
| | - Wei-Te Lei
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, 10065, USA
- Section of Immunology, Rheumatology, and Allergy, Department of Pediatrics, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Anne Puel
- St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, 10065, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM UMR 1163, Necker Hospital for Sick Children, 75015, Paris, France
| | - João Farela Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia-CHLC, EPE, Rua Jacinta Marto, 1169-045, Lisbon, Portugal.
- CEDOC, Chronic Diseases Research Center, NOVA Medical School, Lisbon, Portugal.
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Neves JM, Ramos Pinheiro R, Cordeiro AI, João A, Paiva Lopes MJ. Ulcerated papules and nodules in an infant. Pediatr Dermatol 2020; 37:e49-e50. [PMID: 32706475 DOI: 10.1111/pde.14206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- José Miguel Neves
- Department of Dermatology and Venereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Rita Ramos Pinheiro
- Department of Dermatology and Venereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Ana Isabel Cordeiro
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Alexandre João
- Department of Dermatology and Venereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Maria João Paiva Lopes
- Department of Dermatology and Venereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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Rebelo M, Ding L, Cordeiro AI, Neves C, Simões MJ, Zelazny AM, Holland SM, Neves JF. Fatal Meningitis in Patient with X-Linked Chronic Granulomatous Disease Caused by Virulent Granulibacter bethesdensis. Emerg Infect Dis 2019. [DOI: 10.3201/eid2405.181505] [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] [Indexed: 11/19/2022] Open
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Rebelo M, Ding L, Cordeiro AI, Neves C, Simões MJ, Zelazny AM, Holland SM, Neves JF. Fatal Meningitis in Patient with X-Linked Chronic Granulomatous Disease Caused by Virulent Granulibacter bethesdensis. Emerg Infect Dis 2019; 25:976-979. [PMID: 31002074 PMCID: PMC6478198 DOI: 10.3201/eid2505.181505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Granulibacter bethesdensis is a pathogen reported to cause recurrent lymphadenitis exclusively in persons with chronic granulomatous disease. We report a case of fatal meningitis caused by a highly virulent G. bethesdensis strain in an adolescent in Europe who had chronic granulomatous disease.
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Neves JF, Doffinger R, Barcena-Morales G, Martins C, Papapietro O, Plagnol V, Curtis J, Martins M, Kumararatne D, Cordeiro AI, Neves C, Borrego LM, Katan M, Nejentsev S. Novel PLCG2 Mutation in a Patient With APLAID and Cutis Laxa. Front Immunol 2018; 9:2863. [PMID: 30619256 PMCID: PMC6302768 DOI: 10.3389/fimmu.2018.02863] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/20/2018] [Indexed: 12/27/2022] Open
Abstract
Background: The auto-inflammation and phospholipase Cγ2 (PLCγ2)-associated antibody deficiency and immune dysregulation (APLAID) syndrome is a rare primary immunodeficiency caused by a gain-of-function mutation S707Y in the PLCG2 gene previously described in two patients from one family. The APLAID patients presented with early-onset blistering skin lesions, posterior uveitis, inflammatory bowel disease (IBD) and recurrent sinopulmonary infections caused by a humoral defect, but lacked circulating autoantibodies and had no cold-induced urticaria, contrary to the patients with the related PLAID syndrome. Case: We describe a new APLAID patient who presented with vesiculopustular rash in the 1st weeks of life, followed by IBD, posterior uveitis, recurrent chest infections, interstitial pneumonitis, and also had sensorineural deafness and cutis laxa. Her disease has been refractory to most treatments, including IL1 blockers and a trial with ruxolitinib has been attempted. Results: In this patient, we found a unique de novo heterozygous missense L848P mutation in the PLCG2 gene, predicted to affect the PLCγ2 structure. Similarly to S707Y, the L848P mutation led to the increased basal and EGF-stimulated PLCγ2 activity in vitro. Whole blood assays showed reduced production of IFN-γ and IL-17 in response to polyclonal T-cell stimulation and reduced production of IL-10 and IL-1β after LPS stimulation. Reduced IL-1β levels and the lack of clinical response to treatment with IL-1 blockers argue against NLRP3 inflammasome hyperactivation being the main mechanism mediating the APLAID pathogenesis. Conclusion: Our findings indicate that L848P is novel a gain-of-function mutation that leads to PLCγ2 activation and suggest cutis laxa as a possible clinical manifestations of the APLAID syndrome.
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Affiliation(s)
- João Farela Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia—CHLC, EPE, Lisbon, Portugal
- CEDOC, Chronic Diseases Research Center, NOVA Medical School, Lisbon, Portugal
| | - Rainer Doffinger
- Department of Clinical Biochemistry and Immunology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Gabriela Barcena-Morales
- Laboratorio de Inmunologia, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Catarina Martins
- CEDOC, Chronic Diseases Research Center, NOVA Medical School, Lisbon, Portugal
| | - Olivier Papapietro
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Vincent Plagnol
- University College London Genetics Institute, University College London, London, United Kingdom
| | - James Curtis
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Marta Martins
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Dinakantha Kumararatne
- Department of Clinical Biochemistry and Immunology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ana Isabel Cordeiro
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia—CHLC, EPE, Lisbon, Portugal
| | - Conceição Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia—CHLC, EPE, Lisbon, Portugal
| | - Luis Miguel Borrego
- CEDOC, Chronic Diseases Research Center, NOVA Medical School, Lisbon, Portugal
- Immunoallergy Department, Hospital CUF Descobertas, Lisbon, Portugal
| | - Matilda Katan
- Structural and Molecular Biology, Division of Biosciences, University College London, London, United Kingdom
| | - Sergey Nejentsev
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Molecular Cell Biology and Immunology, Amsterdam University Medical Centers, Amsterdam, Netherlands
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Neves JF, Afonso I, Borrego L, Martins C, Cordeiro AI, Neves C, Lacoste C, Badens C, Fabre A. Missense mutation of TTC7A mimicking tricho-hepato-enteric (SD/THE) syndrome in a patient with very-early onset inflammatory bowel disease. Eur J Med Genet 2017; 61:185-188. [PMID: 29174094 DOI: 10.1016/j.ejmg.2017.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 03/17/2017] [Revised: 10/04/2017] [Accepted: 11/21/2017] [Indexed: 12/13/2022]
Abstract
Tricho-hepato-enteric syndrome (SD/THE) and Multiple intestinal atresia with combined immune deficiency (MIA-CID) are autosomal recessive disorders that present immunological and gastrointestinal features. There are two different phenotypes of patients with TTC7A mutations: the severe form, caused by null mutations and leading to the classical MIA-CID; and the mild form, caused by missense mutations and leading to predominant features of VEO-IBD, less severe immunological involvement and hair abnormalities. We expand the knowledge about TTC7A deficiency, describing a patient with the mild phenotype of TTC7A deficiency but presenting overlapping features of SD/THE and MIA-CID: intestinal atresia and inflammatory bowel disease evocative of MIA-CID, but also dental abnormalities, huge forehead, liver abnormalities, autoimmune thyroiditis and hypogammaglobulinemia, evocative of SD/THE.
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Affiliation(s)
- João Farela Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, CHLC, EPE, Lisbon, Portugal; CEDOC, Chronic Diseases Research Center, NOVA Medical School, Lisboa, Portugal.
| | - Isabel Afonso
- Gastroenterology Unit, Hospital Dona Estefânia, CHLC, EPE, Lisbon, Portugal
| | - Luis Borrego
- CEDOC, Chronic Diseases Research Center, NOVA Medical School, Lisboa, Portugal; Immunoallergy Department, Hospital CUF Descobertas, Lisbon, Portugal
| | - Catarina Martins
- CEDOC, Chronic Diseases Research Center, NOVA Medical School, Lisboa, Portugal
| | - Ana Isabel Cordeiro
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, CHLC, EPE, Lisbon, Portugal
| | - Conceição Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, CHLC, EPE, Lisbon, Portugal
| | - Caroline Lacoste
- Laboratoire de Génétique Moléculaire, Hôpital d'enfants de la Timone, APHM, Marseille, France
| | - Catherine Badens
- Laboratoire de Génétique Moléculaire, Hôpital d'enfants de la Timone, APHM, Marseille, France; Faculté de Médecine, Inserm UMRS 910, Aix-Marseille Université, Marseille, France
| | - Alexandre Fabre
- Faculté de Médecine, Inserm UMRS 910, Aix-Marseille Université, Marseille, France; Service de Pédiatrie Multidisciplinaire, Hôpital d'enfants de la Timone, 264 rue Saint Pierre, APHM, 13005 Marseille, France
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Abstract
Tuberous sclerosis(TS) is an autosomal dominant disease caused by mutations in TSC1 and TSC2 genes. TSC2 gene is located in chromosome 16p13.3, adjacent to PKD1 gene, responsible for the autosomal dominant polycystic kidney disease. In a rare subgroup of patients, the presence of a deletion which simultaneously affects the TSC2 and PKD1 genes has been confirmed. TSC2/PKD1-Contiguous Gene Syndrome is characterised by the early appearance of autosomal dominant polycystic kidney disease in combination with several phenotypic manifestations of TS. We present a 13-year-old girl with bilateral renal cysts detected at the age of 9 months. At the age of 13, she was referred to the Dermatology Outpatients Clinic due to a facial cutaneous eruption. She presented with facial erythema, fibroadenomas with malar distribution and disseminated hypomelanotic macules, meeting the criteria for TS. TSC2/PKD1 Contiguous Gene Syndrome deletion was suspected, being later confirmed by genetic testing.
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Affiliation(s)
| | - Telma Francisco
- Department of Pediatrics, Hospital Dona Estefânia, CHLC, Lisboa, Portugal
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Furtado F, Cordeiro AI, Neves J, Conde M. JIA-like in a boy with Ataxia-telangiectasia. Pediatr Rheumatol Online J 2014. [PMCID: PMC4191249 DOI: 10.1186/1546-0096-12-s1-p212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Casimiro A, Almeida T, Freitas O, Cordeiro AI, Neves C, Neves JF. Successful handling of autoimmunity in X-linked thrombocytopenia (XLT) using mycophenolate mofetil. Pediatr Blood Cancer 2012; 59:961. [PMID: 22692965 DOI: 10.1002/pbc.24222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 05/09/2012] [Indexed: 11/10/2022]
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