The VEXAS Syndrome: Uncontrolled Inflammation and Macrocytic Anaemia in a 77-Year-Old Male Patient.

UNLABELLED

The VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a recently described X-linked autoinflammatory condition caused by a somatic mutation of the UBA1 gene and characterized by an evolving phenotype. This includes inflammatory processes such as recurrent fever, Sweet's syndrome of the skin, pulmonary fibrosis, relapsing polychondritis and venous thromboembolism. An important feature, present in almost all cases, is the development of a macrocytic anaemia with vacuolization of myeloid and erythroid precursors. Usually, these patients require high doses of steroids to control symptoms and respond poorly to disease-modifying drugs. We describe a new case of the VEXAS syndrome presenting with Sweet's syndrome which has now been followed for 6 years.

LEARNING POINTS

An inflammatory syndrome with skin and pulmonary involvement in an elderly male patient with haematological abnormalities such as a macrocytic anaemia, myelodysplastic syndrome or venous thrombotic events should raise suspicion of the VEXAS syndrome.Close collaboration between rheumatologists and haematologists is important in diagnosing and managing this complex disorder.