Multigene sequencing reveals heterogeneity of NLRP12-related autoinflammatory disorders
2018
NLRP12-related autoinflammatory disease (NLRP12-AID) is an exceptionally rare autosomal dominant disorder caused by
germline mutationsin NLRP12 gene. Very few patients with NLRP12-AD have been identified worldwide; therefore, there is a scarcity of data on phenotypic presentation of this syndrome. Here we provide evidence that NLRP12-AID may have clinical manifestations characteristic for primary immune deficiencies (PID). 246 children with
periodic fever(PF) of unknown origin were subjects to the next generation sequencing (NGS) analysis; 213 of these patients had signs of
primary immunodeficiency(PID) manifested by recurrent infections, while 33 kids had isolated PF. The NGS panel was composed of 302 genes implicated in PID and/or AID. 15 patients (9 girls and 6 boys) with NLRP12-AID were identified. Median age of
first AID-related fever episode was 12 months, ranging from 2 months to 13 years. Main clinical features of NLRP12-related AID were
periodic fever(100%), abdominal pain and diarrhea (47%), arthralgia (20%), headache (20%) and
failureto
thrive(33%). Nine patients demonstrated increased susceptibility to infection and two children suffered from Crohn’s disease. Administration of
short coursesof NSAID or corticosteroids resulted in resolution of the disease flare. In one severe case,
canakinumab(anti-interleukin-1β antibody) was successfully used. Significant number of patients with genetically assigned diagnosis of NLPR12-AID has clinical features which close resemble primary immune deficiency. This phenotypic overlap may result in underdiagnosis of NLPR12-AID among patients with PID.
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