First Case of Patient With Two Homozygous Mutations in MYD88 and CARD9 Genes Presenting With Pyogenic Bacterial Infections, Elevated IgE, and Persistent EBV Viremia

Maria Chiriaco, Gigliola Di Matteo, Francesca Conti, Davide Petricone, Maia De Luca, Silvia Di Cesare, Cristina Cifaldi, Rita De Vito, Matteo Zoccolillo, Jessica Serafinelli, Noemi Poerio, Maurizio Fraziano, Immacolata Brigida, Fabio Cardinale, Paolo Rossi, Alessandro Aiuti, Caterina Cancrini, Andrea Finocchi

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Abstract

We described for the first time a female patient with the simultaneous presence of two homozygous mutations in MYD88 and CARD9 genes presenting with pyogenic bacterial infections, elevated IgE, and persistent EBV viremia. In addition to defective TLR/IL1R-signaling, we described novel functional alterations into the myeloid compartment. In particular, we demonstrated a defective production of reactive oxygen species exclusively in monocytes upon E. coli stimulation, the inability of immature mono-derived DCs (iDCs) to differentiate into mature DCs (mDCs) and the incapacity of mono-derived macrophages (MDMs) to resolve BCG infection in vitro. Our data do not provide any evidence for digenic inheritance in our patient, but rather for the association of two monogenic disorders. This case illustrates the importance of using next generation sequencing (NGS) to determine the most accurate and early diagnosis in atypical clinical and immunological phenotypes, and with particular concern in consanguineous families. Indeed, besides the increased susceptibility to recurrent invasive pyogenic bacterial infections due to MYD88 deficiency, the identification of CARD9 mutations underline the risk of developing invasive fungal infections emphasizing the careful monitoring for the occurrence of fungal infection and the opportunity of long-term antifungal prophylaxis.

Original languageEnglish
Pages (from-to)130
JournalFrontiers in Immunology
Volume10
DOIs
Publication statusPublished - Feb 14 2019

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Viremia
Human Herpesvirus 4
Bacterial Infections
Immunoglobulin E
Mutation
Mycoses
Mycobacterium bovis
Genes
Early Diagnosis
Monocytes
Reactive Oxygen Species
Macrophages
Escherichia coli
Phenotype
Infection
In Vitro Techniques
MYD88 Deficiency
Invasive Fungal Infections

Cite this

@article{a0aeddeafde640e3a684c0baa51525a0,
title = "First Case of Patient With Two Homozygous Mutations in MYD88 and CARD9 Genes Presenting With Pyogenic Bacterial Infections, Elevated IgE, and Persistent EBV Viremia",
abstract = "We described for the first time a female patient with the simultaneous presence of two homozygous mutations in MYD88 and CARD9 genes presenting with pyogenic bacterial infections, elevated IgE, and persistent EBV viremia. In addition to defective TLR/IL1R-signaling, we described novel functional alterations into the myeloid compartment. In particular, we demonstrated a defective production of reactive oxygen species exclusively in monocytes upon E. coli stimulation, the inability of immature mono-derived DCs (iDCs) to differentiate into mature DCs (mDCs) and the incapacity of mono-derived macrophages (MDMs) to resolve BCG infection in vitro. Our data do not provide any evidence for digenic inheritance in our patient, but rather for the association of two monogenic disorders. This case illustrates the importance of using next generation sequencing (NGS) to determine the most accurate and early diagnosis in atypical clinical and immunological phenotypes, and with particular concern in consanguineous families. Indeed, besides the increased susceptibility to recurrent invasive pyogenic bacterial infections due to MYD88 deficiency, the identification of CARD9 mutations underline the risk of developing invasive fungal infections emphasizing the careful monitoring for the occurrence of fungal infection and the opportunity of long-term antifungal prophylaxis.",
author = "Maria Chiriaco and {Di Matteo}, Gigliola and Francesca Conti and Davide Petricone and {De Luca}, Maia and {Di Cesare}, Silvia and Cristina Cifaldi and {De Vito}, Rita and Matteo Zoccolillo and Jessica Serafinelli and Noemi Poerio and Maurizio Fraziano and Immacolata Brigida and Fabio Cardinale and Paolo Rossi and Alessandro Aiuti and Caterina Cancrini and Andrea Finocchi",
year = "2019",
month = "2",
day = "14",
doi = "10.3389/fimmu.2019.00130",
language = "English",
volume = "10",
pages = "130",
journal = "Frontiers in Immunology",
issn = "1664-3224",
publisher = "Frontiers Media S.A.",

}

TY - JOUR

T1 - First Case of Patient With Two Homozygous Mutations in MYD88 and CARD9 Genes Presenting With Pyogenic Bacterial Infections, Elevated IgE, and Persistent EBV Viremia

AU - Chiriaco, Maria

AU - Di Matteo, Gigliola

AU - Conti, Francesca

AU - Petricone, Davide

AU - De Luca, Maia

AU - Di Cesare, Silvia

AU - Cifaldi, Cristina

AU - De Vito, Rita

AU - Zoccolillo, Matteo

AU - Serafinelli, Jessica

AU - Poerio, Noemi

AU - Fraziano, Maurizio

AU - Brigida, Immacolata

AU - Cardinale, Fabio

AU - Rossi, Paolo

AU - Aiuti, Alessandro

AU - Cancrini, Caterina

AU - Finocchi, Andrea

PY - 2019/2/14

Y1 - 2019/2/14

N2 - We described for the first time a female patient with the simultaneous presence of two homozygous mutations in MYD88 and CARD9 genes presenting with pyogenic bacterial infections, elevated IgE, and persistent EBV viremia. In addition to defective TLR/IL1R-signaling, we described novel functional alterations into the myeloid compartment. In particular, we demonstrated a defective production of reactive oxygen species exclusively in monocytes upon E. coli stimulation, the inability of immature mono-derived DCs (iDCs) to differentiate into mature DCs (mDCs) and the incapacity of mono-derived macrophages (MDMs) to resolve BCG infection in vitro. Our data do not provide any evidence for digenic inheritance in our patient, but rather for the association of two monogenic disorders. This case illustrates the importance of using next generation sequencing (NGS) to determine the most accurate and early diagnosis in atypical clinical and immunological phenotypes, and with particular concern in consanguineous families. Indeed, besides the increased susceptibility to recurrent invasive pyogenic bacterial infections due to MYD88 deficiency, the identification of CARD9 mutations underline the risk of developing invasive fungal infections emphasizing the careful monitoring for the occurrence of fungal infection and the opportunity of long-term antifungal prophylaxis.

AB - We described for the first time a female patient with the simultaneous presence of two homozygous mutations in MYD88 and CARD9 genes presenting with pyogenic bacterial infections, elevated IgE, and persistent EBV viremia. In addition to defective TLR/IL1R-signaling, we described novel functional alterations into the myeloid compartment. In particular, we demonstrated a defective production of reactive oxygen species exclusively in monocytes upon E. coli stimulation, the inability of immature mono-derived DCs (iDCs) to differentiate into mature DCs (mDCs) and the incapacity of mono-derived macrophages (MDMs) to resolve BCG infection in vitro. Our data do not provide any evidence for digenic inheritance in our patient, but rather for the association of two monogenic disorders. This case illustrates the importance of using next generation sequencing (NGS) to determine the most accurate and early diagnosis in atypical clinical and immunological phenotypes, and with particular concern in consanguineous families. Indeed, besides the increased susceptibility to recurrent invasive pyogenic bacterial infections due to MYD88 deficiency, the identification of CARD9 mutations underline the risk of developing invasive fungal infections emphasizing the careful monitoring for the occurrence of fungal infection and the opportunity of long-term antifungal prophylaxis.

U2 - 10.3389/fimmu.2019.00130

DO - 10.3389/fimmu.2019.00130

M3 - Article

C2 - 30837984

VL - 10

SP - 130

JO - Frontiers in Immunology

JF - Frontiers in Immunology

SN - 1664-3224

ER -