NLRC4 GOF Mutations, a Challenging Diagnosis from Neonatal Age to Adulthood - Archive ouverte HAL Access content directly
Journal Articles Journal of Clinical Medicine Year : 2021

NLRC4 GOF Mutations, a Challenging Diagnosis from Neonatal Age to Adulthood

(1) , (1) , (2, 3) , (2, 3) , (4) , (5, 4, 6, 7) , (8, 1) , (1) , (4, 9) , (6, 4, 9) , (10) , (1, 6) , (1, 5, 6, 7)
1
2
3
4
5
6
7
8
9
10

Abstract

The NLRC4 inflammasome is part of the human immune innate system. Its activation leads to the cleavage of pro-inflammatory cytokines IL-1β and IL-18, promoting inflammation. NLRC4 gain-of-function (GOF) mutations have been associated with early-onset recurrent fever, recurrent macrophagic activation syndrome and enterocolitis. Herein, we describe two new patients with NLRC4 mutations. The first case presented with recurrent fever and vasoplegic syndrome, gut symptoms and urticarial rashes initially misdiagnosed as a severe protein-induced enterocolitis syndrome. The second case had recurrent macrophage activation syndrome (MAS) and shock, suggesting severe infection. We identified two NLRC4 mutations, on exon 4, within the nucleotide-binding protein domain (NBD). After a systematic review of NLRC4 GOF mutations, we highlight the wide spectrum of this disease with a limited genotype-phenotype correlation. Vasoplegic shock was only reported in patients with mutation in the NBD. Diagnosing this new entity combined with gastrointestinal symptoms and vasoplegic shocks is challenging. It mimics severe allergic reaction or sepsis. The plasma IL-18 level and genetic screening are instrumental to make a final diagnosis.
Fichier principal
Vignette du fichier
jcm-10-04369-v3.pdf (1.4 Mo) Télécharger le fichier
Origin : Publisher files allowed on an open archive

Dates and versions

inserm-03834378 , version 1 (29-10-2022)

Identifiers

Cite

J. Bardet, N. Laverdure, M. Fusaro, C. Picard, L. Garnier, et al.. NLRC4 GOF Mutations, a Challenging Diagnosis from Neonatal Age to Adulthood. Journal of Clinical Medicine, 2021, 10 (19), pp.4369. ⟨10.3390/jcm10194369⟩. ⟨inserm-03834378⟩
0 View
0 Download

Altmetric

Share

Gmail Facebook Twitter LinkedIn More