Clinical and molecular features of LRBA.
Abstract
Background : Primary immune regulatory disorders (PIRD) is a new term
coined for a group of PID where autoimmune complications predominate.
Herein we present a case series of 10 cases with lipopolysaccharide
(LPS)-responsive and beige-like anchor protein (LRBA) deficiency who
presented with multiple autoimmunities. Methods: 10 patients with
molecular diagnosis of LRBA deficiency were included and their clinical
data was evaluated. Results: The mean age of onset was 4.3 years. Male
to female ratio was 7:3. 8/10 had 2 or more autoimmune disease with
autoimmune cytopenia being the commonest. Other autoimmune diseases seen
were autoimmune hepatitis, inflammatory bowel disease, enteropathy,
diabetes melitis, thyroiditis, CNS vasculitis, dermatitis and alopecia
areata. All patients had evidence of lymphoproliferation with
generalized lymphadenopathy and/or hepatosplenomegaly. 5/10 had
hypogammaglobinemia, 3/10 had low T cells, two of whom had CD4
lymphopenia. 4/10 had low B and NK cells. 2 had compound heterozygous
and 8 had homozygous mutations in LRBA gene. The treatment was diverse
and included corticosteroids, cyclosporine, azathioprine, cyclosporine,
rituximab, sirolimus and abatacept. One child has undergone successful
HSCT and currently doing well. Conclusion: Patients with LRBA deficiency
present with a broad range of clinical manifestations. High index of
suspicion for a monogenic cause for polyautoimmunity in early childhood
can reduce time delay in diagnosis. With increasing availability of
transplant facilities the outcome for these patients can be
significantly better.