Biallelic mutations in the CFHR genes underlying atypical hemolytic uremic syndrome in a patient with catastrophic adult-onset Still's disease and recurrent macrophage activation syndrome: A case report.

We report the fatal case of a 20-year-old woman with refractory adult-onset Still's disease (AOSD) accompanied by fulminant macrophage activation syndrome (MAS) and atypical hemolytic uremic syndrome (aHUS). Anakinra and tocilizumab temporarily controlled AOSD. In 2021, she presented to ICU with generalized tonic-clonic seizure, lymphocytic aseptic meningitis, and acute kidney injury. Despite hemodialysis and methylprednisolone, she developed another seizure, MAS, and disseminated intravascular coagulation (DIC). Following brief control, MAS flares -reflected by increased plasma CXCL9 and CXCL10- re-emerged and were controlled through dexamethasone, etoposide, cyclosporin and tofacitinib. No mutations were detected in haemophagocytic lymphohistiocytosis (HLH)-associated genes, nor in genes associated with periodic fever syndromes. Post-mortem genetic testing revealed loss-of-function biallelic deletions in complement factor H-related proteins (CFHR) genes, predisposing aHUS. This case underscores the importance of prompt genetic assessment of complement-encoding alleles, in addition to HLH-related genes, in patients with severe AOSD with recurrent MAS and features of thrombotic microangiopathy (TMA).

Papillary thyroid carcinoma presenting with severe Guillain-Barré syndrome.

BACKGROUND: The Guillan-Barré syndrome (GBS) is the most common acute disease of the peripheral nervous system, often necessitating ICU care. Although no clear paraneoplastic syndrome has been defined, it has been known to occur together with several types of cancer. METHODS: We present the case of a 35-year-old man with acute flaccid paralysis and cervical lymphadenopathy. RESULTS: the patient was diagnosed with a severe presentation of GBS and papillary thyroid cancer. After surgical treatment for his cancer, his condition improved and he reached a nearly full recovery. CONCLUSION: our case concerns a young man in whom a severe presentation of GBS led to the diagnosis of thyroid cancer. To our knowledge, this represents the first reported case of this association.