<scp>VEXAS</scp> syndrome: A review of cutaneous findings and treatments in an emerging autoinflammatory disease

VEXAS syndrome (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) is an increasingly recognized disorder that occurs due to somatic mutations of a ubiquitin-activating enzyme encoded by ubiquitin-like modifier activating enzyme 1 gene, UBA1. Clinical findings associated with VEXAS syndrome include recurrent fevers, polychondritis, periorbital edema, pleural effusions, myocarditis and/or pericarditis, hepatosplenomegaly, myelodysplastic syndrome, cytopenias, inflammatory arthritis, neutrophilic dermatosis, and deep venous thrombosis. Novel renal manifestations like interstitial nephritis are infrequent, and to our knowledge, acute renal failure due to C3 glomerulonephritis (C3GN) has not yet been reported. Overwhelming systemic inflammation can result in morbid end-organ damage and death. While there is no formal guideline or established protocol for its management, treatment of VEXAS syndrome with tocilizumab, an interleukin-6 (IL-6)-directed therapy, has been described in the literature. Here, we report a case of a 71-year-old male patient presenting with C3GN as an initial manifestation of VEXAS syndrome and explore the rationale for our approach to treatment with IL-6 blockade. Our patient was initially treated with two inpatient doses of tocilizumab with successful transition to siltuximab in the outpatient setting. He continues to benefit from ongoing siltuximab treatment for more than one year to date without any safety issues or relapse of VEXAS syndrome.

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How Protein Ubiquitination Can Influence Cytokine Expression—Updated Review on Autoinflammatory VEXAS Syndrome

Majer,

Kujawińska,

Limanówka

et al. 2024

Immuno

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VEXAS syndrome is a new disease entity with symptoms that can mimic hematological, rheumatic and dermatological diseases. It is important to take a multidisciplinary approach to patient care, taking into account genetic testing, in which the presence of mutations in the UBA1 gene can confirm the diagnosis. UBA1 mutation has been shown to be involved in the induction of the inflammatory response through many different mechanisms. NF-κB and TNF-α pathways appear to be the most important in VEXAS syndrome. There are many different UBA1 mutations which can result in different outcomes, suggesting it is a possible prognostic factor. Furthermore, mutations differ in how they impair UBA1 function. Cytokines have been shown to be significantly altered in VEXAS patients; however, their exact expression and importance were not clearly defined. Interleukins, such as interleukin (IL)-6, IL-1, IL-2R and others, were reported to be expressed at an altered level, similarly to other cytokines, such as IFN-γ or TNF-α. It is worth noting that the expression of certain cytokines can vary between patients, which poses therapeutic difficulties in selecting the right drug. Therefore, the aim of this review was to describe the cytokines involved in VEXAS syndrome and associate their expression with UBA1 mutation.

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VEXAS syndrome: A review of cutaneous findings and treatments in an emerging autoinflammatory disease

Cited by 4 publications

References 60 publications

Novel use of Siltuximab in a patient with VEXAS Syndrome

Novel use of Siltuximab in a patient with VEXAS Syndrome

Novel Use of Siltuximab in a Patient with Somatic UBA1 Mutated VEXAS Syndrome

How Protein Ubiquitination Can Influence Cytokine Expression—Updated Review on Autoinflammatory VEXAS Syndrome

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