Background Mevalonate kinase deficiency (MKD) is a rare autosomal recessive autoinflammatory disease caused by mutations in MVK gene. MKD patients typically have an early onset of symptoms including recurrent episodes of high fever, abdominal pain, diarrhea and vomiting, arthralgia and lymphadenopathy (AIDAI criteria for HIDS). However not all patients have typical symptoms at the time of onset. MKD treatment remains an unsolved problem, since none of the modalities previously used for MKD treatment are fully effective in the disease control.
Methods We conducted a retrospective analysis of clinical features of twelve patients (6 females, 6 males) with genetically confirmed MKD. Nine patients received therapy with inhibitors of IL-1 (Anakinra and/or Canakinumab). One of the patients died from amyloidosis and macrophage activation syndrome (MAS) prior to treatment initiation, her diagnosis was verified post mortem.
Results Ten patients had manifested within the first 6 months of life, one – at the age of 1.5 years, one – at three years of age,. During the course of the disease all patients had periodic fever and peripheral lymphadenopathy (mainly cervical group), as well as abdominal pain, nausea/vomiting. Five patients had diarrhea, sometimes with blood, one patient suffered from severe constipation. Rash was seen in eight patients, myalgia, artralgia were observed only in six. Oral ulcers were noted in seven children. Three patients had neurological involvement, one patient had it as the main symptom. One patient had periorbital edema and hyperemia during attacks, which to our knowledge, have not been reported previously in MKD. One patient developed amyloidosis and MAS before IL1 inhibitor treatment initiation, which led to her death. In patients receiving anti-IL-1 therapy AIDAI index decreased from 58.3±11,2 before to 1,5±1,4 after 6 month of therapy (p=0.003).
Conclusions MKD symptoms can be variable and sometimes atypical, which requires physician's awareness. In our cohort of MKD patients anti IL-1 therapy was highly effective.
Disclosure of Interest None declared
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