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伴有STAT1突变的常染色体显性遗传性慢性黏膜皮肤念珠菌病可能与慢性活动性肝炎相关:一例报告。

Autosomal dominant chronic mucocutaneous candidiasis with STAT1 mutation can be associated with chronic active hepatitis: A case report.

作者信息

Liu Lingling, Huang Yuan, Liao Yi, Shu Sainan

机构信息

Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

出版信息

Front Pediatr. 2023 Jan 6;10:990729. doi: 10.3389/fped.2022.990729. eCollection 2022.


DOI:10.3389/fped.2022.990729
PMID:36683786
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9852885/
Abstract

BACKGROUND: Chronic mucocutaneous candidiasis (CMC) is a heterogeneous primary immunodeficiency disease characterized by chronic or recurrent infections of the skin, nails, and mucosa and is mostly associated with STAT1 gain-of-function (GOF) mutation (GOF-STAT1 mutation). CASE PRESENTATION: A two-year-old girl was presented with recurrent liver dysfunction, oral candidiasis, acute bronchial pneumonia, and cytomegalovirus infection. Even after a series of treatments, including antifungal voriconazole, nystatin treatment for oral , antibiotics against bacterial infection, and bicyclol to protect the liver, the child still exhibited signs of splenomegaly. Although we performed relevant etiological tests on the child and conducted histopathology and electron microscopic examination of the liver, we could not explain the clinical symptoms. So, a genetic test was conducted to clarify the diagnosis. Since the child suffered recurrent fungal infections, we speculated that she had combined immunodeficiency. Therefore we performed high-precision clinical display PLUS detection and found that the transcription factor STAT1 had a heterozygous GOF mutation (. R274W) in its coiled-coil domain. CONCLUSION: The clinical manifestations of chronic mucocutaneous candidiasis caused by GOF-STAT1 mutations are complex and range from mild local fungal infections to severe systemic diseases and are sometimes fatal. Clinicians need to be aware of the possibility of this disease in children with recurrent fungal infections for early diagnosis and treatment.

摘要

背景:慢性黏膜皮肤念珠菌病(CMC)是一种异质性原发性免疫缺陷疾病,其特征为皮肤、指甲和黏膜的慢性或复发性感染,且大多与信号转导和转录激活因子1(STAT1)功能获得性(GOF)突变(GOF-STAT1突变)相关。 病例报告:一名两岁女童出现反复肝功能障碍、口腔念珠菌病、急性支气管肺炎和巨细胞病毒感染。即便接受了一系列治疗,包括抗真菌的伏立康唑、口腔用制霉菌素治疗、针对细菌感染的抗生素以及用于保护肝脏的双环醇,该患儿仍表现出脾肿大迹象。尽管我们对患儿进行了相关病因学检查,并对肝脏进行了组织病理学和电子显微镜检查,但仍无法解释其临床症状。因此,进行了基因检测以明确诊断。由于该患儿反复发生真菌感染,我们推测她患有联合免疫缺陷。于是我们进行了高精度临床表型PLUS检测,发现转录因子STAT1在其卷曲螺旋结构域存在杂合性GOF突变(.R274W)。 结论:GOF-STAT1突变所致慢性黏膜皮肤念珠菌病的临床表现复杂,从轻度局部真菌感染到严重的全身性疾病不等,有时甚至会致命。临床医生需要意识到反复发生真菌感染的儿童患此病的可能性,以便早期诊断和治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcbc/9852885/03e16e46ade5/fped-10-990729-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcbc/9852885/9f3049ac861a/fped-10-990729-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcbc/9852885/d4626edea55a/fped-10-990729-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcbc/9852885/81ac12a428c0/fped-10-990729-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcbc/9852885/03e16e46ade5/fped-10-990729-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcbc/9852885/9f3049ac861a/fped-10-990729-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcbc/9852885/d4626edea55a/fped-10-990729-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcbc/9852885/81ac12a428c0/fped-10-990729-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dcbc/9852885/03e16e46ade5/fped-10-990729-g004.jpg

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引用本文的文献

[1]
Chinese Chronic Mucocutaneous Candidiasis: A Case Report Series.

Infect Drug Resist. 2024-5-10

本文引用的文献

[1]
Inborn errors of STAT1 immunity.

Curr Opin Immunol. 2021-10

[2]
Cytomegalovirus Hepatitis in Immunocompetent and Immunocompromised Hosts.

J Clin Transl Hepatol. 2021-2-28

[3]
Human STAT1 Gain-of-Function Heterozygous Mutations: Chronic Mucocutaneous Candidiasis and Type I Interferonopathy.

J Clin Immunol. 2020-11

[4]
Human genetic basis of fulminant viral hepatitis.

Hum Genet. 2020-4-13

[5]
Inherited IL-18BP deficiency in human fulminant viral hepatitis.

J Exp Med. 2019-6-18

[6]
Chronic Mucocutaneous Candidiasis in Autoimmune Polyendocrine Syndrome Type 1.

Front Immunol. 2018-11-19

[7]
Chronic mucocutaneous candidiasis due to gain-of-function mutation in STAT1.

Oral Dis. 2018-6-8

[8]
Signal transducer and activator of transcription gain-of-function primary immunodeficiency/immunodysregulation disorders.

Curr Opin Pediatr. 2017-12

[9]
Chronic mucocutaneous candidiasis disease associated with inborn errors of IL-17 immunity.

Clin Transl Immunology. 2016-12-2

[10]
The Extended Clinical Phenotype of 26 Patients with Chronic Mucocutaneous Candidiasis due to Gain-of-Function Mutations in STAT1.

J Clin Immunol. 2016-1

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