BACKGROUND AND OBJECTIVES: Most patients with familial hemophagocytic lymphohistiocytosis (HLH) develop the disease within the first two years of age. In a minority of cases a later occurrence has been reported, with an upper age limit of eight years. A significant concordance of the age at onset within each family has also been observed. RESULTS: We report four cases of families with HLH diagnosed at an unusually late age, comprised between between 9 and 17 years; in each of these families another child developed the disease in infancy. The natural killer activity of the patients was depleted; nevertheless, we had indirect evidence that, in at least two families, mutations of the perforin gene were not causing the disease. INTERPRETATION AND CONCLUSIONS: Such a late onset is very unusual and suggests that there is a subgroup of families with HLH in which the disease may present early or late in different members. Thus in some families with HLH the siblings might remain at risk of developing the disease for several years. Their actual risk cannot be defined until the genetic mutation is identified in each family and assessed in each member.
BACKGROUND AND OBJECTIVES: Most patients with familial hemophagocytic lymphohistiocytosis (HLH) develop the disease within the first two years of age. In a minority of cases a later occurrence has been reported, with an upper age limit of eight years. A significant concordance of the age at onset within each family has also been observed. RESULTS: We report four cases of families with HLH diagnosed at an unusually late age, comprised between between 9 and 17 years; in each of these families another child developed the disease in infancy. The natural killer activity of the patients was depleted; nevertheless, we had indirect evidence that, in at least two families, mutations of the perforin gene were not causing the disease. INTERPRETATION AND CONCLUSIONS: Such a late onset is very unusual and suggests that there is a subgroup of families with HLH in which the disease may present early or late in different members. Thus in some families with HLH the siblings might remain at risk of developing the disease for several years. Their actual risk cannot be defined until the genetic mutation is identified in each family and assessed in each member.
Authors: Isaura P Sánchez; Lucía C Leal-Esteban; Jesús A Álvarez-Álvarez; Camilo A Pérez-Romero; Julio C Orrego; Malyive L Serna; Yadira Coll; Yolanda Caicedo; Edwin Pardo-Díaz; Jacques Zimmer; Jack J Bleesing; José L Franco; Claudia M Trujillo-Vargas Journal: J Clin Immunol Date: 2012-03-22 Impact factor: 8.317
Authors: A Santoro; S Cannella; G Bossi; F Gallo; A Trizzino; D Pende; F Dieli; G Bruno; J C Stinchcombe; C Micalizzi; C De Fusco; C Danesino; L Moretta; L D Notarangelo; G M Griffiths; M Aricò Journal: J Med Genet Date: 2006-07-06 Impact factor: 6.318
Authors: William J Grossman; Mohammed Radhi; Dennis Schauer; Erick Gerday; Charles Grose; Frederick D Goldman Journal: Blood Date: 2005-04-19 Impact factor: 22.113
Authors: Elena Sieni; Valentina Cetica; Andrea Piccin; Filippo Gherlinzoni; Ferdinando Carlo Sasso; Marco Rabusin; Luciano Attard; Alberto Bosi; Daniela Pende; Lorenzo Moretta; Maurizio Aricò Journal: PLoS One Date: 2012-09-07 Impact factor: 3.240