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Phenotypic Variations of Cartilage Hair Hypoplasia: Granulomatous Skin Inflammation and Severe T Cell Immunodeficiency as Initial Clinical Presentation in Otherwise Well Child with Short Stature

Lookup NU author(s): Dr Lisa Turnbull, Dr David Bourn, Dr Christopher Bacon, Dr Michael Wright, Dr Mario Abinun

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Abstract

We report a child with short stature since birth who was otherwise well, presenting at 2.8 years with progressive granulomatous skin lesions when diagnosed with severe T cell immunodeficiency. When previously investigated for short stature, and at the time of current investigations, she had no radiological skeletal features characteristics for cartilage hair hypoplasia, but we found a disease causing RMRP (RNase mitochondrial RNA processing endoribonuclease) gene mutation. Whilst search for HLA matched unrelated donor for haematopoietic stem cell transplantation (HSCT) was underway, she developed rapidly progressive EBV-related lymphoproliferative disorder requiring laparotomy and small bowel resection, and was treated with anti-B cell monoclonal antibody and eventually curative allogeneic HSCT. Screening for RMRP gene mutations should be part of immunological evaluation of patients with 'severe and/or combined' T cell immunodeficiency of unknown origin, especially when associated with short stature and regardless of presence or absence of radiological skeletal features.


Publication metadata

Author(s): McCann LJ, McPartland J, Barge D, Strain L, Bourn D, Calonje E, Verbov J, Riordan A, Kokai G, Bacon CM, Wright M, Abinun M

Publication type: Article

Publication status: Published

Journal: Journal of Clinical Immunology

Year: 2014

Volume: 34

Issue: 1

Pages: 42-48

Print publication date: 12/11/2013

ISSN (print): 0271-9142

ISSN (electronic): 1573-2592

Publisher: Springer

URL: http://dx.doi.org/10.1007/s10875-013-9962-6

DOI: 10.1007/s10875-013-9962-6


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