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[Pseudo-periodic disease with hyperimmunoglobulinemia D: a never-ending story with probable prenatal onset]
E Grouteau1, Y Chaix, D Graber
1Service de médecine infantile A, rhumatologie pédiatrique, hôpital Purpan, Toulouse, France.
Insights
Diagnosing neonatal-onset inflammatory diseases like hyper-IgD syndrome (HIDS) is challenging. Early recognition is crucial as these conditions can be severe and difficult to treat.
Area of Science:
- Pediatric Rheumatology
- Immunology
- Genetics
Background:
- Neonatal-onset inflammatory diseases often present with recurrent fevers, rashes, and systemic inflammation.
- Diagnosis can be delayed, leading to iatrogenic complications and aggressive treatments.
- Hyper-IgD syndrome (HIDS) and CINCA syndrome are rare autoinflammatory disorders with overlapping early symptoms.
Observation:
- A 6-year-old boy experienced recurrent fevers, rashes, gastrointestinal issues, and joint inflammation since birth.
- Initial steroid treatment provided partial improvement, suggesting potential antenatal onset.
Findings:
- The patient was diagnosed with hyper-IgD syndrome (HIDS) at age 4.
- HIDS shares features with Familial Mediterranean Fever and CINCA syndrome, necessitating careful differentiation.
- Elevated serum IgD and IgA levels are characteristic of HIDS, though not entirely specific.
Implications:
- Distinguishing HIDS from similar inflammatory syndromes is vital for appropriate management.
- Effective therapeutic agents for HIDS and CINCA syndrome are not well-established.
- Inflammatory diseases presenting at birth require consideration due to their potential severity.
Unlabelled:
Diagnosis of inflammatory non-infectious diseases with a neonatal onset is often retrospective. It may lead to aggressive and iatrogenic procedures.
Patient:
A 6-year-old boy was suffering, since birth, from recurrent febrile attacks including rashes, gastrointestinal manifestations and inflammatory joint involvement. This syndrome, partially improved with steroids, could have been of antenatal onset. Since the age of 4 years, the patient is considered as having hyper-IgD syndrome (HIDS).
Discussion:
HIDS must be distinguished from familial Mediterranean fever. Patients suffer from recurrent fever concomitant to inflammatory joint involvement, abdominal distress, skin lesions, swollen lymph nodes and hepatosplenomegaly (especially seen in children). All patients have high serum IgD (> 100 UI/mL) and IgA levels. Nevertheless, a high IgD level is not specific. Our case could also be part of the CINCA (chronic, infantile, neurological, cutaneous and articular) syndrome, which includes similar early manifestations associated with a constant neurological and frequent ophthalmological involvement and epiphyseal changes; to date, these last three manifestations are not present in our patient.
Conclusion:
HIDS and CINCA syndrome are not known to be modified by any effective therapeutic agent. When presenting at birth, these inflammatory diseases must be considered as entities with a rarely described potential severity.