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[在一名以慢性腹泻为自身免疫性肠病(IPEX 综合征)表现的婴儿中鉴定出 FOXP3 基因新突变]

[New mutation in FOXP3 gene identified in an infant with chronic diarrhea as manifestation of autoinmune enteropathy - IPEX syndrome].

作者信息

Plata García Clara, Martín-Marín Lorena, Soler-Ramírez Angela, Rojas Jorge A, Salazar María P

机构信息

Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.

Unidad de Genética, Hospital Universitario San Ignacio, Bogotá, Colombia.

出版信息

Rev Chil Pediatr. 2020 Aug;91(4):584-590. doi: 10.32641/rchped.v91i4.1467. Epub 2020 May 23.

Abstract

INTRODUCTION

The IPEX (immune dysregulation, polyendocrinopathy, enteropathy, X-linked) syn drome is caused by the mutations of the FOXP3 gene, characterized by persistent diarrhea, endo crine disorders, and dermatitis. The treatment is the administration of immunosuppressive drugs, where hematopoietic stem cell transplantation is the only potential cure.

OBJECTIVE

To describe a new FOXP3 gene mutation, as well as the findings and evolution of a patient with IPEX syndrome.

CLINICAL CASE

Male infant presenting at one month of age with chronic diarrhea, intestinal failure, and recurrent infections. Lab tests and intestinal biopsy suggested autoimmune enteropathy. During follow-up, the patient presented resistance to immunosuppressive treatment with corticosteroids, cyclosporine, and tacrolimus, dying at 7 months of age due to vascular complications. He had a ma ternal family history of multiple deaths of men under 1 year of age. IPEX syndrome was suspected therefore a trio whole-exome sequencing was performed that showed a probably pathogenic FOXP3 gene mutation.

CONCLUSION

A new FOXP3 gene mutation is reported in a patient with IPEX syndro me. Despite the low prevalence of this disease, it is important to recognize non-specific but suggestive symptoms for its diagnosis.

摘要

引言

免疫失调、多内分泌腺病、肠病、X连锁(IPEX)综合征由FOXP3基因突变引起,其特征为持续性腹泻、内分泌紊乱和皮炎。治疗方法是给予免疫抑制药物,其中造血干细胞移植是唯一可能的治愈方法。

目的

描述一种新的FOXP3基因突变,以及一名IPEX综合征患者的检查结果和病情发展。

临床病例

男婴,1月龄时出现慢性腹泻、肠衰竭和反复感染。实验室检查和肠道活检提示自身免疫性肠病。在随访期间,患者对皮质类固醇、环孢素和他克莫司等免疫抑制治疗产生耐药性,7月龄时因血管并发症死亡。他的母系家族中有多名1岁以下男性死亡的病史。因此怀疑为IPEX综合征,遂进行了三联体全外显子测序,结果显示存在一个可能致病的FOXP3基因突变。

结论

报告了一名IPEX综合征患者的一种新的FOXP3基因突变。尽管该疾病患病率较低,但识别其非特异性但具有提示性的症状对于诊断很重要。

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