RESUMO
Chediak-Higashi syndrome (CHS) is a rare autosomal recessive immunodeficiency disease characterized by frequent infections, hypopigmentation, progressive neurologic deterioration and hemophagocytic lymphohistiocytosis (HLH), known as the accelerated phase. There is little experience in the accelerated phase of CHS treatment worldwide. Here, we present a case of a 9-month-old boy with continuous high fever, hypopigmentation of the skin, enlarged lymph nodes, hepatosplenomegaly and lung infection. He was diagnosed with CHS by gene sequencing, and had entered the accelerated phase. After 8 weeks of therapy, the boy had remission and was prepared for allogenic stem cell transplantation.
Assuntos
Síndrome de Chediak-Higashi/tratamento farmacológico , Síndrome de Chediak-Higashi/genética , Mutação da Fase de Leitura , Síndrome de Chediak-Higashi/patologia , Diagnóstico Tardio , Cabelo/patologia , Humanos , Hipopigmentação/genética , Hipopigmentação/patologia , Lactente , Linfo-Histiocitose Hemofagocítica/genética , Masculino , Pneumonia/diagnóstico por imagem , Pneumonia/genética , Pele/patologia , Resultado do TratamentoRESUMO
INTRODUCTION: Chediak-Higashi syndrome (CHS) is a very rare autosomal recessive disorder (gene CHS1/LYST) characterized by partial albinism, recurrent infections, and easy bruising. Survivors develop a constellation of slowly progressive neurological manifestations. METHODS: We describe clinical, laboratory, electrophysiological, and genetic findings of a patient who developed an immune-mediated demyelinating neuropathy as the main clinical feature of CHS. RESULTS: The patient presented with subacute flaccid paraparesis, absent reflexes, and reduced vibration sense. Protein and immunoglobulins (Igs) were elevated in the cerebrospinal fluid. Electrodiagnostic tests indicated an acquired chronic demyelinating polyneuropathy. Intravenous Ig and immunosuppressant treatment resulted in neurological improvement. The patient later developed organomegaly and pancytopenia. Bone-marrow smear revealed giant azurophilic granules pathognomonic for CHS. Two novel mutations in the LYST gene were identified through whole exome sequencing [c.7786C>T and c.9106 + 1G>T]. CONCLUSIONS: This case expands the clinical phenotype of CHS and highlights inflammatory demyelinating neuropathy as a manifestation of the disease. Muscle Nerve 55: 756-760, 2017.
Assuntos
Síndrome de Chediak-Higashi/complicações , Síndrome de Guillain-Barré/etiologia , Adolescente , Síndrome de Chediak-Higashi/genética , Síndrome de Chediak-Higashi/fisiopatologia , Progressão da Doença , Eletrodiagnóstico , Feminino , Síndrome de Guillain-Barré/genética , Síndrome de Guillain-Barré/fisiopatologia , Humanos , Mutação , Proteínas de Transporte Vesicular/genéticaRESUMO
Chediak-Higashi syndrome (CHS) is a rare autosomal recessive immunodeficiency disease characterized by frequent infections, hypopigmentation, progressive neurologic deterioration and hemophagocytic lymphohistiocytosis (HLH), known as the accelerated phase. There is little experience in the accelerated phase of CHS treatment worldwide. Here, we present a case of a 9-month-old boy with continuous high fever, hypopigmentation of the skin, enlarged lymph nodes, hepatosplenomegaly and lung infection. He was diagnosed with CHS by gene sequencing, and had entered the accelerated phase. After 8 weeks of therapy, the boy had remission and was prepared for allogenic stem cell transplantation.
Assuntos
Humanos , Masculino , Lactente , Síndrome de Chediak-Higashi/tratamento farmacológico , Síndrome de Chediak-Higashi/genética , Mutação da Fase de Leitura , Síndrome de Chediak-Higashi/patologia , Diagnóstico Tardio , Cabelo/patologia , Hipopigmentação/genética , Hipopigmentação/patologia , Linfo-Histiocitose Hemofagocítica/genética , Pneumonia/diagnóstico por imagem , Pneumonia/genética , Pele/patologia , Resultado do TratamentoAssuntos
Albinismo Oculocutâneo/genética , Síndrome de Chediak-Higashi/genética , Albinismo Oculocutâneo/epidemiologia , Sequência de Aminoácidos , Animais , Plaquetas/patologia , Cromossomos Humanos Par 10 , Sequência Conservada , Efeito Fundador , Humanos , Camundongos , Modelos Biológicos , Mutação , Porto Rico/epidemiologia , Suíça , SíndromeRESUMO
One case of Chédiak-Higashi syndrome (CHS) in a black male child, born to a consanguineous couple from a rural village in the State of Falcón, is described. At birth the child had marked skin depigmentation and ash-gray hair. A few months later he developed an almost normal black skin color. The diagnosis of CHS was established by the presence of large peroxidase-positive granules in his leukocytes. Neutrophils showed decreased chemotaxis and lack of digestive capacity against Candida albicans. Unusual features included extreme rarity of CHS in blacks, progressive repigmentation of the skin, and an early benign evolution. A high consanguinity index in the village from which this patient originated raised the possibility of the presence of a new cluster of this disease in Venezuela.
Assuntos
Negro ou Afro-Americano , Síndrome de Chediak-Higashi/epidemiologia , Genes Recessivos , População Negra , Síndrome de Chediak-Higashi/genética , Síndrome de Chediak-Higashi/patologia , Consanguinidade , Grânulos Citoplasmáticos/ultraestrutura , Humanos , Recém-Nascido , Leucócitos/ultraestrutura , Masculino , VenezuelaRESUMO
Os autores apresentam um caso da Síndroma de Chediak-Higashi em crianças de dois anos de idade que faleceu no 13 dia de internaçäo. Säo apresentados os achados anátomo-patológicos e comentados os aspectos imunológicos da síndroma
Assuntos
Pré-Escolar , Humanos , Masculino , Síndrome de Chediak-Higashi/genéticaRESUMO
Endemic Chediak-Higashi Syndrome occurs in a restricted geographic area (Pregonero, State of Táchira, Venezuela). Neutrophils from these patients were unable to digest Candida albicans in vitro, but showed normal or increased metabolic activities. This finding supports the view that the endemic syndrome is bona fide Chediak-Higashi Syndrome.
Assuntos
Síndrome de Chediak-Higashi/fisiopatologia , Neutrófilos/fisiologia , Síndrome de Chediak-Higashi/genética , Humanos , Valores de Referência , VenezuelaRESUMO
Fourteen cases of the Chediak-Higashi syndrome found in twelve non-related families living in a defined geographical area not larger than 200 km2 of the Tachira State, Venezuela (population of around 72,000 inhabitants) were diagnosed between 1967 and 1974. The patients were pre-school or nursing age children except one eleven year old female. Six of the patients were male. All showed the same typical somatic characteristics of this syndrome. Four cases were 2 pairs of brothers. Consanguinity of the parents was seen in only two families, even though the majority of them come from the same restricted geographic zone (Pregonero). Since this anomaly is supposedly produced by a rare recessive autosomal gene, the existence of its high frequency in a small Venezuelan region may be explained through the "founder effect" in a population with a high inbreeding coefficient.