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Human Leukocyte Antigen-B27: The Genetic Predisposition Leading to Reactive Arthritis during Induction Phase
Sandip P Bartakke1, Abhilasha Ashok Sampagar1, Vibha Sanjay Bafna1
1Department of Pediatrics, Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India.
Abstract:
We report a case of reactive arthritis (ReA) during induction phase chemotherapy of a 15-year-old male patient with acute myeloid leukemia (AML) M4 with inv(16), most probably due to a genetic predisposition of being human leukocyte antigen b27 (HLA-B27) positive. The episode of ReA recurred during consolidation therapy; however, the patient was asymptomatic after the completion of treatment. The link between HLA-B27 and a large family of inflammatory rheumatic diseases is a well-established fact, but interestingly, there is also a molecular link between HLA-B27 and hematological malignancies. This case brings to our notice, the common immunological, molecular, and microbiological link between AML, HLA-B27, and ReA. It also emphasizes the fact that clinicians should have a high index of suspicion of HLA-B27 positivity, if a case of AML develops arthritis during chemotherapy, since early introduction of immunosuppressive medications for arthritis may reduce morbidity and prevent delay in the administration of further chemotherapy cycles.
Insights
Reactive arthritis (ReA) occurred in a patient with acute myeloid leukemia (AML) during chemotherapy, likely due to HLA-B27 positivity. This highlights a shared link between AML, HLA-B27, and ReA, necessitating clinical vigilance.
Area of Science:
- Immunology
- Rheumatology
- Hematology
Background:
- Reactive arthritis (ReA) is an inflammatory condition often triggered by infections.
- Acute myeloid leukemia (AML) is a cancer of the blood and bone marrow.
- Human leukocyte antigen B27 (HLA-B27) is a gene associated with various inflammatory diseases.
Observation:
- A 15-year-old male with AML M4 (inv(16)) developed ReA during chemotherapy.
- The ReA recurred during consolidation therapy but resolved post-treatment.
- The patient was positive for HLA-B27.
Findings:
- This case suggests a potential link between AML, HLA-B27 positivity, and the development of ReA.
- A molecular and immunological connection may exist between these conditions.
- The patient's arthritis resolved after chemotherapy completion.
Implications:
- Clinicians should consider HLA-B27 positivity in AML patients developing arthritis during chemotherapy.
- Early immunosuppressive treatment for arthritis may mitigate morbidity.
- Prompt management can prevent delays in essential chemotherapy cycles.
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