Kyoko Yokoi1,2, Sachiko Minamiguchi3, Yoshitaka Honda4, Mizuho Kobayashi5, Satoru Kobayashi6, Ryuta Nishikomori4,7. 1. Department of Pediatrics, Komaki City Hospital, 1-20, Jobushi, Aichi, 485-8520, Komaki, Japan. kyoyo0410@yahoo.co.jp. 2. Department of Pediatrics, Nagoya West Medical Center, Nagoya, Japan. kyoyo0410@yahoo.co.jp. 3. Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan. 4. Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan. 5. Department of Diagnostic Pathology, Nagoya West Medical Center, Nagoya, Japan. 6. Department of Pediatrics, Nagoya West Medical Center, Nagoya, Japan. 7. Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan.
Abstract
BACKGROUND: Cryopyrin-associated periodic syndrome (CAPS) is a life-long, autoinflammatory disease associated with a gain-of-function mutation in the nucleotide-binding domain, leucine-rich repeat family, pyrin domain containing 3 (NLRP3) gene, which result in uncontrolled production of IL-1β and chronic inflammation. Chronic infantile neurologic cutaneous and articular (CINCA) syndrome/neonatal-Onset multisystem inflammatory disease (NOMID) is the most severe form of CAPS. Although the first symptoms may be presented at birth, there are few reports on the involvement of the placenta and umbilical cord in the disease. Therefore, we present herein a preterm case of CINCA/NOMID syndrome and confirms intrauterine-onset inflammation with conclusive evidence by using fetal and placental histopathological examination. CASE PRESENTATION: The female patient was born at 33weeks of gestation by emergency caesarean section and weighted at 1,514 g. The most common manifestations of CINCA/NOMID syndrome including recurrent fever, urticarial rash, and ventriculomegaly due to aseptic meningitis were presented. She also exhibited atypical symptoms such as severe hepatosplenomegaly with cholestasis. The genetic analysis of NLRP3 revealed a heterozygous c.1698 C > G (p.Phe566Leu) mutation, and she was diagnosed with CINCA/NOMID syndrome. Further, a histopathological examination revealed necrotizing funisitis, mainly inflammation of the umbilical artery, along with focal neutrophilic and lymphocytic villitis. CONCLUSIONS: The necrotizing funisitis, which only involved the artery, was an unusual observation for chorioamnionitis. These evidences suggest that foetal inflammation, probably due to overproduction of IL-1β, caused tissue damage in utero, and the first symptom of a newborn with CINCA/NOMID.
BACKGROUND:Cryopyrin-associated periodic syndrome (CAPS) is a life-long, autoinflammatory disease associated with a gain-of-function mutation in the nucleotide-binding domain, leucine-rich repeat family, pyrin domain containing 3 (NLRP3) gene, which result in uncontrolled production of IL-1β and chronic inflammation. Chronic infantile neurologic cutaneous and articular (CINCA) syndrome/neonatal-Onset multisystem inflammatory disease (NOMID) is the most severe form of CAPS. Although the first symptoms may be presented at birth, there are few reports on the involvement of the placenta and umbilical cord in the disease. Therefore, we present herein a preterm case of CINCA/NOMID syndrome and confirms intrauterine-onset inflammation with conclusive evidence by using fetal and placental histopathological examination. CASE PRESENTATION: The female patient was born at 33weeks of gestation by emergency caesarean section and weighted at 1,514 g. The most common manifestations of CINCA/NOMID syndrome including recurrent fever, urticarial rash, and ventriculomegaly due to aseptic meningitis were presented. She also exhibited atypical symptoms such as severe hepatosplenomegaly with cholestasis. The genetic analysis of NLRP3 revealed a heterozygous c.1698 C > G (p.Phe566Leu) mutation, and she was diagnosed with CINCA/NOMID syndrome. Further, a histopathological examination revealed necrotizing funisitis, mainly inflammation of the umbilical artery, along with focal neutrophilic and lymphocytic villitis. CONCLUSIONS: The necrotizing funisitis, which only involved the artery, was an unusual observation for chorioamnionitis. These evidences suggest that foetal inflammation, probably due to overproduction of IL-1β, caused tissue damage in utero, and the first symptom of a newborn with CINCA/NOMID.
Authors: L Cuisset; I Jeru; B Dumont; A Fabre; E Cochet; J Le Bozec; M Delpech; S Amselem; I Touitou Journal: Ann Rheum Dis Date: 2010-11-24 Impact factor: 19.103
Authors: Marco Gattorno; Sara Tassi; Sonia Carta; Laura Delfino; Francesca Ferlito; Maria Antonietta Pelagatti; Andrea D'Osualdo; Antonella Buoncompagni; Maria Giannina Alpigiani; Maria Alessio; Alberto Martini; Anna Rubartelli Journal: Arthritis Rheum Date: 2007-09
Authors: A M Prieur; C Griscelli; F Lampert; H Truckenbrodt; M A Guggenheim; D J Lovell; P Pelkonnen; J Chevrant-Breton; B M Ansell Journal: Scand J Rheumatol Suppl Date: 1987