Cutaneous Granulomas in Ataxia Telangiectasia and Other Primary Immunodeficiencies: Reflection of Inappropriate Immune Regulation?

Chiam, Lynn Yuun Tirng; Verhagen, Mijke M.M.; Haraldsson, Ásgeir; Wulffraat, N. M.; Driessen, Gertjan J.; Netea, M.G.; Weemaes, C.M.R.; Seyger, M.M.B.; Deuren, Marcel van

doi:10.1159/000330335

Cited by 64 publications

(79 citation statements)

References 85 publications

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“…In addition to increased susceptibility to infections, these patients can present a broad range of symptoms such as autoimmunity, granulomatous inflammation, lymphoproliferation, and increased risk of malignancy [66,67]. Granulomatous inflammation has been reported in patients with various genetic defects (Table 5), mainly hypomorphic recombination-activating gene (RAG) mutations [68], hypomorphic Artemis deficiency [69], hypomorphic JAK3 deficiency [70], CD40L deficiency [71], ataxia telangiectasia [72], Nijmegen breakage syndrome [73], cartilage hair hypoplasia [74], and lipopolysaccharideresponsive beige-like anchor (LRBA) deficiency [75]. It has also been reported in a patient as a complication of low immune reconstitution after a haploidentical hematopoietic stem cell transplantation (HSCT) for an X-linked SCID [76].…”

Section: Systemic Granulomatous Disordersmentioning

confidence: 99%

Granulomatous inflammation: The overlap of immune deficiency and inflammation

Rosé

Neven

Wouters

2014

Best Practice & Research Clinical Rheumatology

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Section: Systemic Granulomatous Disordersmentioning

confidence: 99%

Granulomatous inflammation: The overlap of immune deficiency and inflammation

Rosé

Neven

Wouters

2014

Best Practice & Research Clinical Rheumatology

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“…Fewer than 10% of people with A-T develop chronic cutaneous granulomas that are thought to be due to disordered inflammation [35, 36]. …”

Section: Introductionmentioning

confidence: 99%

Ataxia telangiectasia: a review

Rothblum-Oviatt

Wright²,

Lefton‐Greif

et al. 2016

Orphanet J Rare Dis

486

488

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Definition of the diseaseAtaxia telangiectasia (A-T) is an autosomal recessive disorder primarily characterized by cerebellar degeneration, telangiectasia, immunodeficiency, cancer susceptibility and radiation sensitivity. A-T is often referred to as a genome instability or DNA damage response syndrome.EpidemiologyThe world-wide prevalence of A-T is estimated to be between 1 in 40,000 and 1 in 100,000 live births.Clinical descriptionA-T is a complex disorder with substantial variability in the severity of features between affected individuals, and at different ages. Neurological symptoms most often first appear in early childhood when children begin to sit or walk. They have immunological abnormalities including immunoglobulin and antibody deficiencies and lymphopenia. People with A-T have an increased predisposition for cancers, particularly of lymphoid origin. Pulmonary disease and problems with feeding, swallowing and nutrition are common, and there also may be dermatological and endocrine manifestations.EtiologyA-T is caused by mutations in the ATM (Ataxia Telangiectasia, Mutated) gene which encodes a protein of the same name. The primary role of the ATM protein is coordination of cellular signaling pathways in response to DNA double strand breaks, oxidative stress and other genotoxic stress.DiagnosisThe diagnosis of A-T is usually suspected by the combination of neurologic clinical features (ataxia, abnormal control of eye movement, and postural instability) with one or more of the following which may vary in their appearance: telangiectasia, frequent sinopulmonary infections and specific laboratory abnormalities (e.g. IgA deficiency, lymphopenia especially affecting T lymphocytes and increased alpha-fetoprotein levels). Because certain neurological features may arise later, a diagnosis of A-T should be carefully considered for any ataxic child with an otherwise elusive diagnosis. A diagnosis of A-T can be confirmed by the finding of an absence or deficiency of the ATM protein or its kinase activity in cultured cell lines, and/or identification of the pathological mutations in the ATM gene.Differential diagnosisThere are several other neurologic and rare disorders that physicians must consider when diagnosing A-T and that can be confused with A-T. Differentiation of these various disorders is often possible with clinical features and selected laboratory tests, including gene sequencing.Antenatal diagnosisAntenatal diagnosis can be performed if the pathological ATM mutations in that family have been identified in an affected child. In the absence of identifying mutations, antenatal diagnosis can be made by haplotype analysis if an unambiguous diagnosis of the affected child has been made through clinical and laboratory findings and/or ATM protein analysis.Genetic counselingGenetic counseling can help family members of a patient with A-T understand when genetic testing for A-T is feasible, and how the test results should be interpreted.Management and prognosisTreatment of the neurologic problems associated wit...

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“…Furthermore, there are several reports on patients presenting with chronic cutaneous granulomas and pulmonary inflammation without apparent underlying infections. [14][15][16][17] Although the immune defects in the adaptive arm of the immune system associated with this disease have been well studied, the effects on the innate immune system remain poorly understood.…”

Section: Introductionmentioning

confidence: 99%