Phenocopies of primary immunodeficiency: Difference between revisions
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{{ID}} | {{ID}} | ||
{{CMG}}; {{AE}} {{Akram}}, {{Anmol}} | {{CMG}}; {{AE}} {{Sab}}, {{Akram}}, {{Anmol}} | ||
==Overview== | ==Overview== | ||
These disorders behave and present like primary PIDs, but they are acquired secondary to the occurrence of autoantibodies or somatic mutations.<ref name="pmid26454309">{{cite journal| author=Raje N, Dinakar C| title=Overview of Immunodeficiency Disorders. | journal=Immunol Allergy Clin North Am | year= 2015 | volume= 35 | issue= 4 | pages= 599-623 | pmid=26454309 | doi=10.1016/j.iac.2015.07.001 | pmc=4600970 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26454309 }} </ref>These conditions are not caused by inherited genetic mutations, but instead are acquired during life. | |||
==Classification== | ==Classification== | ||
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{{Family tree | | | | | A01 | | | | |A01=Phenocopies of PID}} | {{Family tree | | | | | A01 | | | | |A01=Phenocopies of PID}} | ||
{{Family tree | | |,|-|-|^|-|-|.| | |}} | {{Family tree | | |,|-|-|^|-|-|.| | |}} | ||
{{Family tree | | B01 | {{Family tree | | B01 | | | | B02 | | |B01=Associated with somatic mutations|B02=Associated with auto-antibodies}} | ||
{{Family tree | |! | {{Family tree | |!| | | | | |!| | | | |}} | ||
{{Family tree | |)| C01 | {{Family tree | |)| C01 | | |)| D01 | |C01=ALPS-SFAS|D01=Chronic mucocutaneous candidiasis}} | ||
{{Family tree | |! | {{Family tree | |!| | | | | |!| | | | |}} | ||
{{Family tree | |)| C02 | {{Family tree | |)| C02 | | |)| D02 | |C02=RALD (RAS-associated autoimmune leukoproliferative disease)|D02=Adult-onset immunodeficiency with susceptibility to mycobacteria}} | ||
{{Family tree | |! | {{Family tree | |!| | | | | |!| | | | |}} | ||
{{Family tree | |)| C03 | {{Family tree | |)| C03 | | |)| D03 | |C03=Cryopyrinopathy (Muckle-Wells Syndrome)|D03=Recurrent skin infections}} | ||
{{Family tree | |! | {{Family tree | |!| | | | | |!| | | | | |}} | ||
{{Family tree | |`| C04 | {{Family tree | |`| C04 | | |)| D04 | | |C04=[[Hypereosinophilic syndrome|Hypereosinophilic syndrome due to somatic mutations in STAT5b]]|D04=[[Pulmonary alveolar proteinosis]]}} | ||
{{Family tree | {{Family tree | | | | | | | |!| | | | | |}} | ||
{{Family tree | {{Family tree | | | | | | | |)| D05 | | |D05=[[Angioedema|Acquired angioedema]]}} | ||
{{Family tree | {{Family tree | | | | | | | |!| | | | | |}} | ||
{{Family tree | {{Family tree | | | | | | | |)| D06 | | |D06=[[Hemolytic uremic syndrome|Atypical hemolytic uremic syndrome]]}} | ||
{{Family tree | {{Family tree | | | | | | | |!| | | | | |}} | ||
{{Family tree | {{Family tree | | | | | | | |`| D07 | | |D07=[[Thymoma|Thymoma with hypogammaglobulinemia]]}} | ||
{{Family tree/end}} | {{Family tree/end}} | ||
==ALPS-SFAS== | ==Autoimmune Lymphoproliferative Syndrome due to Somatic FAS Mutations (ALPS-SFAS)== | ||
* | *ALPS-SFAS is a heritable disorder of [[apoptosis]], resulting in the accumulation of autoreactive [[lymphocytes]].<ref name="pmid20360470">{{cite journal| author=Dowdell KC, Niemela JE, Price S, Davis J, Hornung RL, Oliveira JB et al.| title=Somatic FAS mutations are common in patients with genetically undefined autoimmune lymphoproliferative syndrome. | journal=Blood | year= 2010 | volume= 115 | issue= 25 | pages= 5164-9 | pmid=20360470 | doi=10.1182/blood-2010-01-263145 | pmc=2892951 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20360470 }} </ref> | ||
*Manifests in early childhood as nonmalignant lymphadenopathy with hepatosplenomegaly and | *Manifests in early childhood as nonmalignant [[lymphadenopathy]] with [[hepatosplenomegaly]] and [[Autoimmunity|autoimmune]] [[Cytopenia|cytopenias]]. | ||
*Patients with mutations have developed B and T-cell lymphomas.<ref name="pmid11418480">{{cite journal| author=Straus SE, Jaffe ES, Puck JM, Dale JK, Elkon KB, Rösen-Wolff A et al.| title=The development of lymphomas in families with autoimmune lymphoproliferative syndrome with germline Fas mutations and defective lymphocyte apoptosis. | journal=Blood | year= 2001 | volume= 98 | issue= 1 | pages= 194-200 | pmid=11418480 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11418480 }} </ref> | *Patients with mutations have developed B and T-cell [[Lymphoma|lymphomas]].<ref name="pmid11418480">{{cite journal| author=Straus SE, Jaffe ES, Puck JM, Dale JK, Elkon KB, Rösen-Wolff A et al.| title=The development of lymphomas in families with autoimmune lymphoproliferative syndrome with germline Fas mutations and defective lymphocyte apoptosis. | journal=Blood | year= 2001 | volume= 98 | issue= 1 | pages= 194-200 | pmid=11418480 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11418480 }} </ref> | ||
*Peripheral blood analysis in patients has demonstrated hypergammaglobulinemia along with increased numbers of B and T lymphocytes.<ref name="pmid1386609">{{cite journal| author=Sneller MC, Straus SE, Jaffe ES, Jaffe JS, Fleisher TA, Stetler-Stevenson M et al.| title=A novel lymphoproliferative/autoimmune syndrome resembling murine lpr/gld disease. | journal=J Clin Invest | year= 1992 | volume= 90 | issue= 2 | pages= 334-41 | pmid=1386609 | doi=10.1172/JCI115867 | pmc=443107 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1386609 }} </ref> | *Peripheral blood analysis in patients has demonstrated [[hypergammaglobulinemia]] along with increased numbers of B and T lymphocytes.<ref name="pmid1386609">{{cite journal| author=Sneller MC, Straus SE, Jaffe ES, Jaffe JS, Fleisher TA, Stetler-Stevenson M et al.| title=A novel lymphoproliferative/autoimmune syndrome resembling murine lpr/gld disease. | journal=J Clin Invest | year= 1992 | volume= 90 | issue= 2 | pages= 334-41 | pmid=1386609 | doi=10.1172/JCI115867 | pmc=443107 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1386609 }} </ref> | ||
*Some studies have demonstrated that ALPS is compatible with long-term survival.<ref name="pmid8929361">{{cite journal| author=Drappa J, Vaishnaw AK, Sullivan KE, Chu JL, Elkon KB| title=Fas gene mutations in the Canale-Smith syndrome, an inherited lymphoproliferative disorder associated with autoimmunity. | journal=N Engl J Med | year= 1996 | volume= 335 | issue= 22 | pages= 1643-9 | pmid=8929361 | doi=10.1056/NEJM199611283352204 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8929361 }} </ref><ref name="pmid4165068">{{cite journal| author=Canale VC, Smith CH| title=Chronic lymphadenopathy simulating malignant lymphoma. | journal=J Pediatr | year= 1967 | volume= 70 | issue= 6 | pages= 891-9 | pmid=4165068 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4165068 }} </ref> | *Some studies have demonstrated that ALPS is compatible with long-term survival.<ref name="pmid8929361">{{cite journal| author=Drappa J, Vaishnaw AK, Sullivan KE, Chu JL, Elkon KB| title=Fas gene mutations in the Canale-Smith syndrome, an inherited lymphoproliferative disorder associated with autoimmunity. | journal=N Engl J Med | year= 1996 | volume= 335 | issue= 22 | pages= 1643-9 | pmid=8929361 | doi=10.1056/NEJM199611283352204 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8929361 }} </ref><ref name="pmid4165068">{{cite journal| author=Canale VC, Smith CH| title=Chronic lymphadenopathy simulating malignant lymphoma. | journal=J Pediatr | year= 1967 | volume= 70 | issue= 6 | pages= 891-9 | pmid=4165068 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4165068 }} </ref> | ||
== | ==RAS-Associated Autoimmune Leukoproliferative Disease (RALD)== | ||
*RALD is a leukoproliferative disorder characterized by [[lymphadenopathy]], [[splenomegaly]], and variable [[autoimmune]] phenomena, including [[autoimmune hemolytic anemia]], [[idiopathic thrombocytopenic purpura]], and [[neutropenia]].<ref name="pmid24240292">{{cite journal| author=Oliveira JB| title=The expanding spectrum of the autoimmune lymphoproliferative syndromes. | journal=Curr Opin Pediatr | year= 2013 | volume= 25 | issue= 6 | pages= 722-9 | pmid=24240292 | doi=10.1097/MOP.0000000000000032 | pmc=4435794 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24240292 }} </ref><ref name="pmid21079152">{{cite journal| author=Niemela JE, Lu L, Fleisher TA, Davis J, Caminha I, Natter M et al.| title=Somatic KRAS mutations associated with a human nonmalignant syndrome of autoimmunity and abnormal leukocyte homeostasis. | journal=Blood | year= 2011 | volume= 117 | issue= 10 | pages= 2883-6 | pmid=21079152 | doi=10.1182/blood-2010-07-295501 | pmc=3062298 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21079152 }} </ref> | |||
* | |||
*Some patients have recurrent infections with increased risk of hematologic malignancy.<ref name="pmid24240292">{{cite journal| author=Oliveira JB| title=The expanding spectrum of the autoimmune lymphoproliferative syndromes. | journal=Curr Opin Pediatr | year= 2013 | volume= 25 | issue= 6 | pages= 722-9 | pmid=24240292 | doi=10.1097/MOP.0000000000000032 | pmc=4435794 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24240292 }} </ref><ref name="pmid21079152">{{cite journal| author=Niemela JE, Lu L, Fleisher TA, Davis J, Caminha I, Natter M et al.| title=Somatic KRAS mutations associated with a human nonmalignant syndrome of autoimmunity and abnormal leukocyte homeostasis. | journal=Blood | year= 2011 | volume= 117 | issue= 10 | pages= 2883-6 | pmid=21079152 | doi=10.1182/blood-2010-07-295501 | pmc=3062298 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21079152 }} </ref> | *Some patients have recurrent infections with increased risk of hematologic malignancy.<ref name="pmid24240292">{{cite journal| author=Oliveira JB| title=The expanding spectrum of the autoimmune lymphoproliferative syndromes. | journal=Curr Opin Pediatr | year= 2013 | volume= 25 | issue= 6 | pages= 722-9 | pmid=24240292 | doi=10.1097/MOP.0000000000000032 | pmc=4435794 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24240292 }} </ref><ref name="pmid21079152">{{cite journal| author=Niemela JE, Lu L, Fleisher TA, Davis J, Caminha I, Natter M et al.| title=Somatic KRAS mutations associated with a human nonmalignant syndrome of autoimmunity and abnormal leukocyte homeostasis. | journal=Blood | year= 2011 | volume= 117 | issue= 10 | pages= 2883-6 | pmid=21079152 | doi=10.1182/blood-2010-07-295501 | pmc=3062298 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21079152 }} </ref> | ||
*Mutated genes involved include NRAS and [[KRAS]]. | |||
==Cryopyrinopathy(Muckle-Wells Syndrome)== | ==Cryopyrinopathy (Muckle-Wells Syndrome)== | ||
* | *Cryopyrinopathy is caused by [[heterozygous]] mutation in the gene encoding cryopyrin (NLRP3) and the locus identified at chromosome 1q44.<ref name="pmid11687797">{{cite journal| author=Hoffman HM, Mueller JL, Broide DH, Wanderer AA, Kolodner RD| title=Mutation of a new gene encoding a putative pyrin-like protein causes familial cold autoinflammatory syndrome and Muckle-Wells syndrome. | journal=Nat Genet | year= 2001 | volume= 29 | issue= 3 | pages= 301-5 | pmid=11687797 | doi=10.1038/ng756 | pmc=4322000 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11687797 }} </ref><ref name="pmid10486324">{{cite journal| author=Cuisset L, Drenth JP, Berthelot JM, Meyrier A, Vaudour G, Watts RA et al.| title=Genetic linkage of the Muckle-Wells syndrome to chromosome 1q44. | journal=Am J Hum Genet | year= 1999 | volume= 65 | issue= 4 | pages= 1054-9 | pmid=10486324 | doi=10.1086/302589 | pmc=1288238 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10486324 }} </ref> | ||
*Characterized by episodic skin rash, arthralgias, and fever associated with late-onset sensorineural deafness and renal amyloidosis.<ref name="pmid11992256">{{cite journal| author=Dodé C, Le Dû N, Cuisset L, Letourneur F, Berthelot JM, Vaudour G et al.| title=New mutations of CIAS1 that are responsible for Muckle-Wells syndrome and familial cold urticaria: a novel mutation underlies both syndromes. | journal=Am J Hum Genet | year= 2002 | volume= 70 | issue= 6 | pages= 1498-506 | pmid=11992256 | doi= | pmc=379138 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11992256 }} </ref> | *Characterized by episodic skin rash, [[arthralgias]], and fever associated with late-onset [[sensorineural deafness]] and [[renal amyloidosis]].<ref name="pmid11992256">{{cite journal| author=Dodé C, Le Dû N, Cuisset L, Letourneur F, Berthelot JM, Vaudour G et al.| title=New mutations of CIAS1 that are responsible for Muckle-Wells syndrome and familial cold urticaria: a novel mutation underlies both syndromes. | journal=Am J Hum Genet | year= 2002 | volume= 70 | issue= 6 | pages= 1498-506 | pmid=11992256 | doi= | pmc=379138 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11992256 }} </ref> | ||
*Limb pains emphasized on as a feature.<ref name="pmid5769632">{{cite journal| author=Black JT| title=Amyloidosis, deafness, urticaria, and limb pains: a hereditary syndrome. | journal=Ann Intern Med | year= 1969 | volume= 70 | issue= 5 | pages= 989-94 | pmid=5769632 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5769632 }} </ref> | *Limb pains emphasized on as a feature.<ref name="pmid5769632">{{cite journal| author=Black JT| title=Amyloidosis, deafness, urticaria, and limb pains: a hereditary syndrome. | journal=Ann Intern Med | year= 1969 | volume= 70 | issue= 5 | pages= 989-94 | pmid=5769632 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5769632 }} </ref> | ||
==Hypereosinophilic Syndrome due to Somatic Mutations in STAT5b== | |||
*Hypereosinophilic syndrome due to somatic mutations in STAT5b is characterized by [[atopic dermatitis]], [[Urticaria|urticarial]] rash, [[diarrhea]] and [[eosinophilia]] | |||
==Chronic Mucocutaneous Candidiasis== | |||
*Chronic mucocutaneous candidiasis includes a group of rare disorders with altered immune responses, selective against [[Candida]].<ref name="pmid12205111">{{cite journal| author=Zuccarello D, Salpietro DC, Gangemi S, Toscano V, Merlino MV, Briuglia S et al.| title=Familial chronic nail candidiasis with ICAM-1 deficiency: a new form of chronic mucocutaneous candidiasis. | journal=J Med Genet | year= 2002 | volume= 39 | issue= 9 | pages= 671-5 | pmid=12205111 | doi= | pmc=1735231 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12205111 }} </ref> | |||
*Characterized by persistent and/or recurrent infections of the skin, nails and mucous membranes caused mainly by [[Candida albicans|C''andida albicans'']].<ref name="pmid12205111">{{cite journal| author=Zuccarello D, Salpietro DC, Gangemi S, Toscano V, Merlino MV, Briuglia S et al.| title=Familial chronic nail candidiasis with ICAM-1 deficiency: a new form of chronic mucocutaneous candidiasis. | journal=J Med Genet | year= 2002 | volume= 39 | issue= 9 | pages= 671-5 | pmid=12205111 | doi= | pmc=1735231 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12205111 }} </ref> | |||
*Can also be associated with [[Autoimmune polyendocrine syndrome|autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy]] ([[APECED]]) syndrome which is driven by mutations in [[AIRE]] ([[Autoimmunity|autoimmune]] regulator).<ref name="pmid2348835">{{cite journal| author=Ahonen P, Myllärniemi S, Sipilä I, Perheentupa J| title=Clinical variation of autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) in a series of 68 patients. | journal=N Engl J Med | year= 1990 | volume= 322 | issue= 26 | pages= 1829-36 | pmid=2348835 | doi=10.1056/NEJM199006283222601 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2348835 }} </ref><ref name="pmid9398839">{{cite journal| author=Nagamine K, Peterson P, Scott HS, Kudoh J, Minoshima S, Heino M et al.| title=Positional cloning of the APECED gene. | journal=Nat Genet | year= 1997 | volume= 17 | issue= 4 | pages= 393-8 | pmid=9398839 | doi=10.1038/ng1297-393 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9398839 }} </ref><ref name="pmid9398840">{{cite journal| author=Finnish-German APECED Consortium| title=An autoimmune disease, APECED, caused by mutations in a novel gene featuring two PHD-type zinc-finger domains. | journal=Nat Genet | year= 1997 | volume= 17 | issue= 4 | pages= 399-403 | pmid=9398840 | doi=10.1038/ng1297-399 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9398840 }} </ref> | |||
*High titers of neutralizing [[Autoantibody|autoantibodies]] against IL-17 and/or IL-22 are also detected.<ref name="pmid20123958">{{cite journal| author=Puel A, Döffinger R, Natividad A, Chrabieh M, Barcenas-Morales G, Picard C et al.| title=Autoantibodies against IL-17A, IL-17F, and IL-22 in patients with chronic mucocutaneous candidiasis and autoimmune polyendocrine syndrome type I. | journal=J Exp Med | year= 2010 | volume= 207 | issue= 2 | pages= 291-7 | pmid=20123958 | doi=10.1084/jem.20091983 | pmc=2822614 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20123958 }} </ref> | |||
==Adult-Onset Immunodeficiency with Susceptibility to Mycobacteria== | |||
*Adult-onset immunodeficiency with susceptibility to mycobacteria is a disorder predominantly found in Southeast Asians.<ref name="pmid23652167">{{cite journal| author=Chan JF, Trendell-Smith NJ, Chan JC, Hung IF, Tang BS, Cheng VC et al.| title=Reactive and infective dermatoses associated with adult-onset immunodeficiency due to anti-interferon-gamma autoantibody: Sweet's syndrome and beyond. | journal=Dermatology | year= 2013 | volume= 226 | issue= 2 | pages= 157-66 | pmid=23652167 | doi=10.1159/000347112 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23652167 }} </ref><ref name="pmid26011559">{{cite journal| author=Pithukpakorn M, Roothumnong E, Angkasekwinai N, Suktitipat B, Assawamakin A, Luangwedchakarn V et al.| title=HLA-DRB1 and HLA-DQB1 Are Associated with Adult-Onset Immunodeficiency with Acquired Anti-Interferon-Gamma Autoantibodies. | journal=PLoS One | year= 2015 | volume= 10 | issue= 5 | pages= e0128481 | pmid=26011559 | doi=10.1371/journal.pone.0128481 | pmc=4444022 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26011559 }} </ref> | |||
*Associated with severe or disseminated infections caused by [[Nontuberculous mycobacteria|non-tuberculous mycobacteria]] and other [[Opportunistic pathogen|opportunistic pathogens]] such as [[Salmonella|non-typhoidal salmonella]], [[cytomegalovirus]], [[varicella zoster virus]], and some [[Fungus|fungi]].<ref name="pmid22913682">{{cite journal| author=Browne SK, Burbelo PD, Chetchotisakd P, Suputtamongkol Y, Kiertiburanakul S, Shaw PA et al.| title=Adult-onset immunodeficiency in Thailand and Taiwan. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 8 | pages= 725-34 | pmid=22913682 | doi=10.1056/NEJMoa1111160 | pmc=4190026 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22913682 }} </ref><ref name="pmid22403254">{{cite journal| author=Browne SK, Zaman R, Sampaio EP, Jutivorakool K, Rosen LB, Ding L et al.| title=Anti-CD20 (rituximab) therapy for anti-IFN-γ autoantibody-associated nontuberculous mycobacterial infection. | journal=Blood | year= 2012 | volume= 119 | issue= 17 | pages= 3933-9 | pmid=22403254 | doi=10.1182/blood-2011-12-395707 | pmc=3350360 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22403254 }} </ref> | |||
*An [[infection]] may act as an initial trigger for the production of [[Autoantibody|autoantibodies]] with repeated [[infections]] leading to increased activity.<ref name="pmid22913682">{{cite journal| author=Browne SK, Burbelo PD, Chetchotisakd P, Suputtamongkol Y, Kiertiburanakul S, Shaw PA et al.| title=Adult-onset immunodeficiency in Thailand and Taiwan. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 8 | pages= 725-34 | pmid=22913682 | doi=10.1056/NEJMoa1111160 | pmc=4190026 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22913682 }} </ref><ref name="pmid22403254">{{cite journal| author=Browne SK, Zaman R, Sampaio EP, Jutivorakool K, Rosen LB, Ding L et al.| title=Anti-CD20 (rituximab) therapy for anti-IFN-γ autoantibody-associated nontuberculous mycobacterial infection. | journal=Blood | year= 2012 | volume= 119 | issue= 17 | pages= 3933-9 | pmid=22403254 | doi=10.1182/blood-2011-12-395707 | pmc=3350360 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22403254 }} </ref> | |||
==Recurrent Skin Infections== | |||
*Patients with recurrent [[staphylococcal]] [[cellulitis]] and [[subcutaneous]] [[Abscess|abscesses]] have shown high titers of [[IgG|IgG1]] [[Autoantibody|autoantibodies]] against [[Interleukin 6|IL-6]], a [[Pleiotropy|pleiotropic]] [[cytokine]] released by several important cellular lineages of the skin.<ref name="pmid18097067">{{cite journal| author=Puel A, Picard C, Lorrot M, Pons C, Chrabieh M, Lorenzo L et al.| title=Recurrent staphylococcal cellulitis and subcutaneous abscesses in a child with autoantibodies against IL-6. | journal=J Immunol | year= 2008 | volume= 180 | issue= 1 | pages= 647-54 | pmid=18097067 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18097067 }} </ref><ref name="pmid8634514">{{cite journal| author=Paquet P, Piérard GE| title=Interleukin-6 and the skin. | journal=Int Arch Allergy Immunol | year= 1996 | volume= 109 | issue= 4 | pages= 308-17 | pmid=8634514 | doi=10.1159/000237257 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8634514 }} </ref> | |||
*The [[Autoantibody|autoantibodies]] against [[Interleukin 6|IL-6]] prevent the increase in [[C-reactive protein]] ([[C-reactive protein|CRP]]) concentration during [[infection]] and the impaired [[Interleukin 6|IL-6]] mediated [[immunity]] contributes to the disease development.<ref name="pmid18097067">{{cite journal| author=Puel A, Picard C, Lorrot M, Pons C, Chrabieh M, Lorenzo L et al.| title=Recurrent staphylococcal cellulitis and subcutaneous abscesses in a child with autoantibodies against IL-6. | journal=J Immunol | year= 2008 | volume= 180 | issue= 1 | pages= 647-54 | pmid=18097067 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18097067 }} </ref> | |||
*[[Autosomal dominant]] deficiency of signal transducer and activator of transcription 3 ([[STAT3]]) can also lead to [[cutaneous]] infections typically caused by [[Staphylococcus aureus|''Staphylococcus aureus'']].<ref name="pmid22751495">{{cite journal| author=Chandesris MO, Melki I, Natividad A, Puel A, Fieschi C, Yun L et al.| title=Autosomal dominant STAT3 deficiency and hyper-IgE syndrome: molecular, cellular, and clinical features from a French national survey. | journal=Medicine (Baltimore) | year= 2012 | volume= 91 | issue= 4 | pages= e1-19 | pmid=22751495 | doi=10.1097/MD.0b013e31825f95b9 | pmc=3680355 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22751495 }} </ref> | |||
==Pulmonary Alveolar Proteinosis== | |||
*[[Pulmonary alveolar proteinosis]] is characterized by intra-alveolar [[surfactant]] accumulation. | |||
*A severe [[Autoimmunity|autoimmune]] disease caused by [[Autoantibody|autoantibodies]] against [[Granulocyte macrophage colony stimulating factor|granulocyte–macrophage colony-stimulating factor]] ([[Granulocyte macrophage colony stimulating factor|GM-CSF]]) resulting in impaired function of alveolar [[Macrophage|macrophages]].<ref name="pmid26077231">{{cite journal| author=Piccoli L, Campo I, Fregni CS, Rodriguez BM, Minola A, Sallusto F et al.| title=Neutralization and clearance of GM-CSF by autoantibodies in pulmonary alveolar proteinosis. | journal=Nat Commun | year= 2015 | volume= 6 | issue= | pages= 7375 | pmid=26077231 | doi=10.1038/ncomms8375 | pmc=4477037 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26077231 }} </ref> | |||
*Lung [[biopsy]] shows preserved lung architecture with alveoli filled with granular, [[eosinophilic]] [[Periodic acid-Schiff stain|PAS-positive]] material with degenerating [[macrophages]].<ref name="pmid14695413">{{cite journal| author=Trapnell BC, Whitsett JA, Nakata K| title=Pulmonary alveolar proteinosis. | journal=N Engl J Med | year= 2003 | volume= 349 | issue= 26 | pages= 2527-39 | pmid=14695413 | doi=10.1056/NEJMra023226 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14695413 }} </ref> | |||
*Hereditary [[pulmonary alveolar proteinosis]] may be caused by compound [[heterozygous]] abnormalities affecting the CSF2RA gene and CSF2 signaling, critical for [[surfactant]] [[homeostasis]] in humans.<ref name="pmid18955570">{{cite journal| author=Suzuki T, Sakagami T, Rubin BK, Nogee LM, Wood RE, Zimmerman SL et al.| title=Familial pulmonary alveolar proteinosis caused by mutations in CSF2RA. | journal=J Exp Med | year= 2008 | volume= 205 | issue= 12 | pages= 2703-10 | pmid=18955570 | doi=10.1084/jem.20080990 | pmc=2585845 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18955570 }} </ref> | |||
*Patients with [[pulmonary alveolar proteinosis]] can also present with [[Cryptococcal Meningitis|cryptococcal meningitis]] in the setting of anti-[[Granulocyte macrophage colony stimulating factor|GM-CSF]] [[Autoantibody|autoantibodies]] as [[Granulocyte macrophage colony stimulating factor|GM-CSF]] regulates the function of [[phagocytes]] and pulmonary alveolar [[macrophages]], critical elements in [[Cryptococcus|cryptococcal]] control.<ref name="pmid29181420">{{cite journal| author=Crum-Cianflone NF, Lam PV, Ross-Walker S, Rosen LB, Holland SM| title=Autoantibodies to Granulocyte-Macrophage Colony-Stimulating Factor Associated With Severe and Unusual Manifestations of Cryptococcus gattii Infections. | journal=Open Forum Infect Dis | year= 2017 | volume= 4 | issue= 4 | pages= ofx211 | pmid=29181420 | doi=10.1093/ofid/ofx211 | pmc=5695620 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29181420 }} </ref><ref name="pmid23509356">{{cite journal| author=Rosen LB, Freeman AF, Yang LM, Jutivorakool K, Olivier KN, Angkasekwinai N et al.| title=Anti-GM-CSF autoantibodies in patients with cryptococcal meningitis. | journal=J Immunol | year= 2013 | volume= 190 | issue= 8 | pages= 3959-66 | pmid=23509356 | doi=10.4049/jimmunol.1202526 | pmc=3675663 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23509356 }} </ref> | |||
For more information on [[pulmonary alveolar proteinosis]], [[Pulmonary alveolar proteinosis|click here]]. | |||
==Acquired Angioedema== | |||
*Acquired angioedema is rare disorder that causes recurrent episodes of swelling ([[edema]]) of the face or body. | |||
*The [[edema]] can involve the lining of the [[digestive tract]] causing [[abdominal pain]] and may require unnecessary [[laparotomy]]. It can also involve the [[upper airway]], which can be life-threatening.<ref name="pmid3653633">{{cite journal| author=Weinstock LB, Kothari T, Sharma RN, Rosenfeld SI| title=Recurrent abdominal pain as the sole manifestation of hereditary angioedema in multiple family members. | journal=Gastroenterology | year= 1987 | volume= 93 | issue= 5 | pages= 1116-8 | pmid=3653633 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3653633 }} </ref><ref name="pmid8628358">{{cite journal| author=Waytes AT, Rosen FS, Frank MM| title=Treatment of hereditary angioedema with a vapor-heated C1 inhibitor concentrate. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 25 | pages= 1630-4 | pmid=8628358 | doi=10.1056/NEJM199606203342503 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8628358 }} </ref> | |||
*It can occur due to the deficiency of [[C1-inhibitor|C1 inhibitor]] in the setting of [[Autoantibody|autoantibodies]] against it.<ref name="pmid3534579">{{cite journal| author=Jackson J, Sim RB, Whelan A, Feighery C| title=An IgG autoantibody which inactivates C1-inhibitor. | journal=Nature | year= 1986 | volume= 323 | issue= 6090 | pages= 722-4 | pmid=3534579 | doi=10.1038/323722a0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3534579 }} </ref><ref name="pmid3494945">{{cite journal| author=Alsenz J, Bork K, Loos M| title=Autoantibody-mediated acquired deficiency of C1 inhibitor. | journal=N Engl J Med | year= 1987 | volume= 316 | issue= 22 | pages= 1360-6 | pmid=3494945 | doi=10.1056/NEJM198705283162202 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3494945 }} </ref><ref name="pmid2454251">{{cite journal| author=Malbran A, Hammer CH, Frank MM, Fries LF| title=Acquired angioedema: observations on the mechanism of action of autoantibodies directed against C1 esterase inhibitor. | journal=J Allergy Clin Immunol | year= 1988 | volume= 81 | issue= 6 | pages= 1199-204 | pmid=2454251 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2454251 }} </ref> | |||
*It has been associated with benign or malignant B-cell [[lymphoproliferative disorders]] such as [[chronic lymphocytic leukemia]], [[multiple myeloma]], or [[Cryoglobulinemia|essential cryoglobulinemia.]]<ref name="pmid449665">{{cite journal| author=Gelfand JA, Boss GR, Conley CL, Reinhart R, Frank MM| title=Acquired C1 esterase inhibitor deficiency and angioedema: a review. | journal=Medicine (Baltimore) | year= 1979 | volume= 58 | issue= 4 | pages= 321-8 | pmid=449665 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=449665 }} </ref> | |||
==Atypical Hemolytic Uremic Syndrome (aHUS)== | |||
*Atypical hemolytic uremic syndrome is a rare form of [[thrombotic microangiopathy]] that associates, in 70% of cases, with genetic or acquired disorders leading to dysregulation of the [[alternative complement pathway]].<ref name="pmid21051740">{{cite journal| author=Dragon-Durey MA, Sethi SK, Bagga A, Blanc C, Blouin J, Ranchin B et al.| title=Clinical features of anti-factor H autoantibody-associated hemolytic uremic syndrome. | journal=J Am Soc Nephrol | year= 2010 | volume= 21 | issue= 12 | pages= 2180-7 | pmid=21051740 | doi=10.1681/ASN.2010030315 | pmc=3014031 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21051740 }} </ref> | |||
*It can present with [[anemia]], [[thrombocytopenia]], [[hypertension]], and [[Acute kidney injury|acute renal failure]]. Renal biopsy shows a [[thrombotic microangiopathy]] and deposition of [[C3 (complement)|complement component C3]] in vessel walls.<ref name="pmid9551389">{{cite journal| author=Warwicker P, Goodship TH, Donne RL, Pirson Y, Nicholls A, Ward RM et al.| title=Genetic studies into inherited and sporadic hemolytic uremic syndrome. | journal=Kidney Int | year= 1998 | volume= 53 | issue= 4 | pages= 836-44 | pmid=9551389 | doi=10.1111/j.1523-1755.1998.00824.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9551389 }} </ref> | |||
*[[Autoantibody|Autoantibodies]] against [[factor H]] causes at least 6% to 10% of [[Hemolytic-uremic syndrome|aHUS]] cases.<ref name="pmid21051740">{{cite journal| author=Dragon-Durey MA, Sethi SK, Bagga A, Blanc C, Blouin J, Ranchin B et al.| title=Clinical features of anti-factor H autoantibody-associated hemolytic uremic syndrome. | journal=J Am Soc Nephrol | year= 2010 | volume= 21 | issue= 12 | pages= 2180-7 | pmid=21051740 | doi=10.1681/ASN.2010030315 | pmc=3014031 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21051740 }} </ref> | |||
*[[Hemolytic-uremic syndrome|aHUS]] in the setting of [[antibodies]] against [[factor H]] primarily affects children between 9 and 13 years old but it also affects adults.<ref name="pmid21051740">{{cite journal| author=Dragon-Durey MA, Sethi SK, Bagga A, Blanc C, Blouin J, Ranchin B et al.| title=Clinical features of anti-factor H autoantibody-associated hemolytic uremic syndrome. | journal=J Am Soc Nephrol | year= 2010 | volume= 21 | issue= 12 | pages= 2180-7 | pmid=21051740 | doi=10.1681/ASN.2010030315 | pmc=3014031 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21051740 }} </ref> | |||
==Thymoma with Hypogammaglobulinemia (Good Syndrome)== | |||
*Good syndrome is a rare acquired combined [[T cell|T-]] and [[B cell|B-cell]] [[immunodeficiency]] associated with [[thymoma]].<ref name="pmid20175853">{{cite journal| author=Hanafusa T, Umegaki N, Yamaguchi Y, Katayama I| title=Good's syndrome (hypogammaglobulinemia with thymoma) presenting intractable opportunistic infections and hyperkeratotic lichen planus. | journal=J Dermatol | year= 2010 | volume= 37 | issue= 2 | pages= 171-4 | pmid=20175853 | doi=10.1111/j.1346-8138.2009.00781.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20175853 }} </ref> | |||
*It can present with intractable [[Opportunistic infection|opportunistic infections]], [[lichen planus]] and therapy resistant [[Diarrhea|secretory diarrhea]].<ref name="pmid20175853">{{cite journal| author=Hanafusa T, Umegaki N, Yamaguchi Y, Katayama I| title=Good's syndrome (hypogammaglobulinemia with thymoma) presenting intractable opportunistic infections and hyperkeratotic lichen planus. | journal=J Dermatol | year= 2010 | volume= 37 | issue= 2 | pages= 171-4 | pmid=20175853 | doi=10.1111/j.1346-8138.2009.00781.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20175853 }} </ref><ref name="pmid27571946">{{cite journal| author=Disselhorst MJ, Dickhoff C, Alhan C| title=Good's syndrome: an uncommon cause of therapy-resistant diarrhoea. | journal=Neth J Med | year= 2016 | volume= 74 | issue= 7 | pages= 309-12 | pmid=27571946 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27571946 }} </ref> | |||
*Laboratory examination results indicate [[hypogammaglobulinemia]] and complete absence or decrease in the proportion of cells bearing [[B cell|B cells]] markers.<ref name="pmid20175853">{{cite journal| author=Hanafusa T, Umegaki N, Yamaguchi Y, Katayama I| title=Good's syndrome (hypogammaglobulinemia with thymoma) presenting intractable opportunistic infections and hyperkeratotic lichen planus. | journal=J Dermatol | year= 2010 | volume= 37 | issue= 2 | pages= 171-4 | pmid=20175853 | doi=10.1111/j.1346-8138.2009.00781.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20175853 }} </ref><ref name="pmid11991514">{{cite journal| author=Oshikiri T, Morikawa T, Sugiura H, Katoh H| title=Thymoma associated with hypogammaglobulinemia (Good's syndrome): report of a case. | journal=Surg Today | year= 2002 | volume= 32 | issue= 3 | pages= 264-6 | pmid=11991514 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11991514 }} </ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{{WS}} | |||
[[Category:Medicine]] | |||
[[Category:Immunology]] | |||
[[Category:Hematology]] | |||
[[Category:Genetics]] |
Latest revision as of 19:14, 23 October 2018
Immunodeficiency Main Page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2], Ali Akram, M.B.B.S.[3], Anmol Pitliya, M.B.B.S. M.D.[4]
Overview
These disorders behave and present like primary PIDs, but they are acquired secondary to the occurrence of autoantibodies or somatic mutations.[1]These conditions are not caused by inherited genetic mutations, but instead are acquired during life.
Classification
Phenocopies of PID | |||||||||||||||||||||||||||
Associated with somatic mutations | Associated with auto-antibodies | ||||||||||||||||||||||||||
ALPS-SFAS | Chronic mucocutaneous candidiasis | ||||||||||||||||||||||||||
RALD (RAS-associated autoimmune leukoproliferative disease) | Adult-onset immunodeficiency with susceptibility to mycobacteria | ||||||||||||||||||||||||||
Cryopyrinopathy (Muckle-Wells Syndrome) | Recurrent skin infections | ||||||||||||||||||||||||||
Hypereosinophilic syndrome due to somatic mutations in STAT5b | Pulmonary alveolar proteinosis | ||||||||||||||||||||||||||
Acquired angioedema | |||||||||||||||||||||||||||
Atypical hemolytic uremic syndrome | |||||||||||||||||||||||||||
Thymoma with hypogammaglobulinemia | |||||||||||||||||||||||||||
Autoimmune Lymphoproliferative Syndrome due to Somatic FAS Mutations (ALPS-SFAS)
- ALPS-SFAS is a heritable disorder of apoptosis, resulting in the accumulation of autoreactive lymphocytes.[2]
- Manifests in early childhood as nonmalignant lymphadenopathy with hepatosplenomegaly and autoimmune cytopenias.
- Patients with mutations have developed B and T-cell lymphomas.[3]
- Peripheral blood analysis in patients has demonstrated hypergammaglobulinemia along with increased numbers of B and T lymphocytes.[4]
- Some studies have demonstrated that ALPS is compatible with long-term survival.[5][6]
RAS-Associated Autoimmune Leukoproliferative Disease (RALD)
- RALD is a leukoproliferative disorder characterized by lymphadenopathy, splenomegaly, and variable autoimmune phenomena, including autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura, and neutropenia.[7][8]
- Some patients have recurrent infections with increased risk of hematologic malignancy.[7][8]
- Mutated genes involved include NRAS and KRAS.
Cryopyrinopathy (Muckle-Wells Syndrome)
- Cryopyrinopathy is caused by heterozygous mutation in the gene encoding cryopyrin (NLRP3) and the locus identified at chromosome 1q44.[9][10]
- Characterized by episodic skin rash, arthralgias, and fever associated with late-onset sensorineural deafness and renal amyloidosis.[11]
- Limb pains emphasized on as a feature.[12]
Hypereosinophilic Syndrome due to Somatic Mutations in STAT5b
- Hypereosinophilic syndrome due to somatic mutations in STAT5b is characterized by atopic dermatitis, urticarial rash, diarrhea and eosinophilia
Chronic Mucocutaneous Candidiasis
- Chronic mucocutaneous candidiasis includes a group of rare disorders with altered immune responses, selective against Candida.[13]
- Characterized by persistent and/or recurrent infections of the skin, nails and mucous membranes caused mainly by Candida albicans.[13]
- Can also be associated with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) syndrome which is driven by mutations in AIRE (autoimmune regulator).[14][15][16]
- High titers of neutralizing autoantibodies against IL-17 and/or IL-22 are also detected.[17]
Adult-Onset Immunodeficiency with Susceptibility to Mycobacteria
- Adult-onset immunodeficiency with susceptibility to mycobacteria is a disorder predominantly found in Southeast Asians.[18][19]
- Associated with severe or disseminated infections caused by non-tuberculous mycobacteria and other opportunistic pathogens such as non-typhoidal salmonella, cytomegalovirus, varicella zoster virus, and some fungi.[20][21]
- An infection may act as an initial trigger for the production of autoantibodies with repeated infections leading to increased activity.[20][21]
Recurrent Skin Infections
- Patients with recurrent staphylococcal cellulitis and subcutaneous abscesses have shown high titers of IgG1 autoantibodies against IL-6, a pleiotropic cytokine released by several important cellular lineages of the skin.[22][23]
- The autoantibodies against IL-6 prevent the increase in C-reactive protein (CRP) concentration during infection and the impaired IL-6 mediated immunity contributes to the disease development.[22]
- Autosomal dominant deficiency of signal transducer and activator of transcription 3 (STAT3) can also lead to cutaneous infections typically caused by Staphylococcus aureus.[24]
Pulmonary Alveolar Proteinosis
- Pulmonary alveolar proteinosis is characterized by intra-alveolar surfactant accumulation.
- A severe autoimmune disease caused by autoantibodies against granulocyte–macrophage colony-stimulating factor (GM-CSF) resulting in impaired function of alveolar macrophages.[25]
- Lung biopsy shows preserved lung architecture with alveoli filled with granular, eosinophilic PAS-positive material with degenerating macrophages.[26]
- Hereditary pulmonary alveolar proteinosis may be caused by compound heterozygous abnormalities affecting the CSF2RA gene and CSF2 signaling, critical for surfactant homeostasis in humans.[27]
- Patients with pulmonary alveolar proteinosis can also present with cryptococcal meningitis in the setting of anti-GM-CSF autoantibodies as GM-CSF regulates the function of phagocytes and pulmonary alveolar macrophages, critical elements in cryptococcal control.[28][29]
For more information on pulmonary alveolar proteinosis, click here.
Acquired Angioedema
- Acquired angioedema is rare disorder that causes recurrent episodes of swelling (edema) of the face or body.
- The edema can involve the lining of the digestive tract causing abdominal pain and may require unnecessary laparotomy. It can also involve the upper airway, which can be life-threatening.[30][31]
- It can occur due to the deficiency of C1 inhibitor in the setting of autoantibodies against it.[32][33][34]
- It has been associated with benign or malignant B-cell lymphoproliferative disorders such as chronic lymphocytic leukemia, multiple myeloma, or essential cryoglobulinemia.[35]
Atypical Hemolytic Uremic Syndrome (aHUS)
- Atypical hemolytic uremic syndrome is a rare form of thrombotic microangiopathy that associates, in 70% of cases, with genetic or acquired disorders leading to dysregulation of the alternative complement pathway.[36]
- It can present with anemia, thrombocytopenia, hypertension, and acute renal failure. Renal biopsy shows a thrombotic microangiopathy and deposition of complement component C3 in vessel walls.[37]
- Autoantibodies against factor H causes at least 6% to 10% of aHUS cases.[36]
- aHUS in the setting of antibodies against factor H primarily affects children between 9 and 13 years old but it also affects adults.[36]
Thymoma with Hypogammaglobulinemia (Good Syndrome)
- Good syndrome is a rare acquired combined T- and B-cell immunodeficiency associated with thymoma.[38]
- It can present with intractable opportunistic infections, lichen planus and therapy resistant secretory diarrhea.[38][39]
- Laboratory examination results indicate hypogammaglobulinemia and complete absence or decrease in the proportion of cells bearing B cells markers.[38][40]
References
- ↑ Raje N, Dinakar C (2015). "Overview of Immunodeficiency Disorders". Immunol Allergy Clin North Am. 35 (4): 599–623. doi:10.1016/j.iac.2015.07.001. PMC 4600970. PMID 26454309.
- ↑ Dowdell KC, Niemela JE, Price S, Davis J, Hornung RL, Oliveira JB; et al. (2010). "Somatic FAS mutations are common in patients with genetically undefined autoimmune lymphoproliferative syndrome". Blood. 115 (25): 5164–9. doi:10.1182/blood-2010-01-263145. PMC 2892951. PMID 20360470.
- ↑ Straus SE, Jaffe ES, Puck JM, Dale JK, Elkon KB, Rösen-Wolff A; et al. (2001). "The development of lymphomas in families with autoimmune lymphoproliferative syndrome with germline Fas mutations and defective lymphocyte apoptosis". Blood. 98 (1): 194–200. PMID 11418480.
- ↑ Sneller MC, Straus SE, Jaffe ES, Jaffe JS, Fleisher TA, Stetler-Stevenson M; et al. (1992). "A novel lymphoproliferative/autoimmune syndrome resembling murine lpr/gld disease". J Clin Invest. 90 (2): 334–41. doi:10.1172/JCI115867. PMC 443107. PMID 1386609.
- ↑ Drappa J, Vaishnaw AK, Sullivan KE, Chu JL, Elkon KB (1996). "Fas gene mutations in the Canale-Smith syndrome, an inherited lymphoproliferative disorder associated with autoimmunity". N Engl J Med. 335 (22): 1643–9. doi:10.1056/NEJM199611283352204. PMID 8929361.
- ↑ Canale VC, Smith CH (1967). "Chronic lymphadenopathy simulating malignant lymphoma". J Pediatr. 70 (6): 891–9. PMID 4165068.
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