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| [Paper Type: Article] AND [Author: Manson, David] (3) | 1 Apr 2025 |
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- OPEN ACCESSIntroduction: Cartilage–hair hypoplasia (CHH) is a rare skeletal dysplasia that presents with various degrees of immunodeficiency, short stature, and a susceptibility to malignancies. Individuals with CHH can present with severe combined immunodeficiency or combined immunodeficiency and are at risk for severe and unusual infections irrespective of their laboratory findings. In addition, individuals with CHH can present with variable skeletal abnormalities, mainly involving the metaphysis of long bones. CHH is a rare disease and familiarity with the variable features is crucial for diagnosis.Methods: We report the clinical, radiological, and genetic findings for 5 patients with proven diagnoses of CHH.Results: In this study we describe a cohort of patients with CHH and present their clinical findings and progressions. In addition, we present the radiological images and the immunological investigations that were done in these patients. Although all the patients in our cohort had poor cellular immunity, they had a variable clinical course. Three out of 5 patients received a bone marrow transplant (BMT) and 2 out of 5 died at an early age (1 after BMT). Those who had poor humoral function had a worse prognosis compared with those with good humoral function. The skeletal findings were characteristic for CHH.Conclusion: CHH is a disease with a variable presentation. Clinicians should be aware of the characteristic skeletal and immunological findings to identify the disease as early as possible.Statement of novelty: We present novel clinical and radiological findings in patients with variable RMRP gene mutations.
- OPEN ACCESSChronic granulomatous disease (CGD) is a primary immunodeficiency caused by defects in any of the subunits of nicotinamide adenine dinucleotide phosphate oxidase complex, required for proper phagocyte killing of bacteria and fungi. Most of the cases are X-linked, but autosomal recessive cases have also been identified. Patients suffer from recurrent, life-threatening infections and granulomatous inflammation of the skin, lymph nodes, lungs, liver, spleen, brain, and bones. CGD can be cured by hematopoietic stem cell transplantation. Imaging studies such as radiography, ultrasound, computed tomography, and magnetic resonance imaging play a key role in identifying the changes driven by both infection and dysregulated inflammation. These studies are critical for guiding management of this disorder. We present the most illustrative images from 7 patients with CGD.Statement of novelty: Imaging studies are highly useful for diagnosis, treatment, and follow-up of patients with CGD. We present images from children with CGD that manifested their disease in different organs and tissues, illustrating the typical location of infections and dysregulated inflammation in these types of patients.
- OPEN ACCESSBackground: Hyper IgE syndrome (HIES) is a primary immunodeficiency with sporadic, autosomal dominant (STAT3 mutation) and autosomal recessive (DOCK8 and TYK2 mutations) inheritance patterns. HIES is characterized by recurrent Staphylococcus infections including lung infections, skin and visceral abcesses, pulmonary pneumatoceles, mucocutaneous candidiasis, and eczematous rash with associated elevated IgE. Patients with STAT3 mutations have additional features including connective tissue, skeletal, dental, and vascular abnormalities.Methods: This case series highlights the clinical presentation, radiographic findings, and immunologic investigations of 4 siblings with HIES caused by STAT3 mutation.Results: Our patients presented with infections including Staphylococcus aureus visceral abscesses, skin lesions, pneumonia with associated pneumatocele, and minimal signs of inflammation such as fever. Additional characteristic features included eczematous rash, scoliosis, fractures, and delayed shedding of primary teeth. Immune investigations were essentially unremarkable apart from elevated IgE and eosinophil counts. Detailed imaging identified infectious processes and associated noninfectious features of STAT3 mutations.Conclusion: Patients presenting with recurrent Staphylococcal cutaneous and visceral infections, pneumatoceles, candidiasis, and eczematous rash with associated elevated IgE should be investigated for STAT3 mutations. This case series highlights the important role of radiographic imaging to identify infectious processes as well as noninfectious associated features in patients with STAT3 mutations.Statement of novelty: Detailed images of morbidity associated with a STAT3 deficiency.
