Eren Akarcan Sanem, Ulusoy Severcan Ezgi, Edeer Karaca Neslihan, Isik Esra, Aksu Guzide, Migaud Mélanie, Evin Gurkan Ferda, Azarsiz Elif, Puel Anne, Casanova Jean-Laurent, Kutukculer Necil
Ege University Medical Faculty, Department of Pediatric Immunology, Izmir, Turkey.
Ege University Medical Faculty, Department of Pediatric Genetics, Izmir, Turkey.
Case Reports Immunol. 2017;2017:2846928. doi: 10.1155/2017/2846928. Epub 2017 Nov 13.
Chronic Mucocutaneous Candidiasis (CMC) is the chronic, recurrent, noninvasive Candida infections of the skin, mucous membranes, and nails. A 26-month-old girl was admitted with the complaints of recurrent oral Candidiasis, diarrhea, and respiratory infections. grew in oral mucosa swab. CMV and EBV DNA titers were elevated. She had hypergammaglobulinemia; IgE level, percentages of lymphocyte subgroups, and in vitro T-cell proliferation responses were normal. She had parenchymal nodules within the lungs and a calcific nodule in the liver. Chronic-recurrent infections with different pathogens leading to significant morbidity suggested combined immunodeficiency, CMC, or Mendelian susceptibility to mycobacterial diseases. Genetic analysis revealed a predefined heterozygous gain-of-function mutation (GOF) (c.1154 C>T, p.Thr385Met) in the gene coding STAT1 molecule. Hematopoietic stem cell transplantation (HSCT) was planned because of severe recurring infections. Patients with GOF mutations may exhibit diverse phenotypes including infectious and noninfectious findings. HSCT should be considered as an early treatment option before permanent organ damage leading to morbidity and mortality develops. This case is presented to prompt clinicians to consider GOF mutations in the differential diagnosis of patients with chronic Candidiasis and recurrent infections with multiple organisms, since these mutations are responsible for nearly half of CMC cases reported.
慢性黏膜皮肤念珠菌病(CMC)是皮肤、黏膜和指甲的慢性复发性非侵袭性念珠菌感染。一名26个月大的女孩因反复出现口腔念珠菌病、腹泻和呼吸道感染入院。口腔黏膜拭子培养阳性。巨细胞病毒(CMV)和EB病毒(EBV)DNA滴度升高。她有高球蛋白血症;免疫球蛋白E(IgE)水平、淋巴细胞亚群百分比和体外T细胞增殖反应正常。她肺部有实质性结节,肝脏有钙化结节。不同病原体的慢性复发性感染导致严重发病,提示存在联合免疫缺陷、CMC或孟德尔遗传性分枝杆菌病易感性。基因分析显示,编码信号转导和转录激活因子1(STAT1)分子的基因存在一个预先定义的杂合功能获得性突变(GOF)(c.1154 C>T,p.Thr385Met)。由于严重的反复感染,计划进行造血干细胞移植(HSCT)。携带GOF突变的患者可能表现出多种表型,包括感染性和非感染性表现。在导致发病和死亡的永久性器官损伤出现之前,应将HSCT视为一种早期治疗选择。呈现此病例是为了促使临床医生在慢性念珠菌病和多种病原体反复感染患者的鉴别诊断中考虑GOF突变,因为这些突变导致了近一半报道的CMC病例。