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Mutations in the TNFAIP3 gene resulting in A20 haploinsufficiency (HA20) have been identified as a new cause of autoinflammation linked to uncontrolled nuclear factor kappa B (NF-κB) activation.1 A recent report published in the Annals of the Rheumatic Diseases highlighted the main clinical manifestations of the 16 patients who presented with recurrent oral, genital, gastrointestinal ulcerations and various inflammatory features (skin lesions, musculoskeletal disorders and recurrent fever) associated in some cases to autoimmunity mimicking a lupus.2 Some of the patients also experienced recurrent infections. TNFAIP3 anomalies included monoallelic nonsense and frameshift mutations.1
Here, we report that HA20 can be part of a more complex genetic syndrome. We describe the new case of a boy who presented with mild intellectual disability with normal MRI and dysmorphic features including short stature, large forehead, thin lips and visible muscles (figure 1A). Of note, he had a heterotaxis with …
Handling editor Josef S Smolen
Contributors SV wrote and revised the manuscript. EC draw the pictures and panel. LB, RP performed the immunological experiments and analysis. MT, IT, GS performed the genetic experiments (CGH array and exome sequencing) and analysis. LV performed CT scan and annotated panel B. TW supervised immunological work and reviewed the manuscript. AB is in charge of the patient and supervised the work. All authors critically reviewed the manuscript.
Funding This study is funded by Agence Nationale de la Recherche (grant number: ANR LUMUGENE 2014).
Competing interests None declared.
Patient consent Obtained.
Ethics approval Medical Ethics Committee of Sud Est III, Lyon, France.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data available (raw data for genetic studies could be provided).
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