- A case of early interferonopathy in a child using modern recommendations for their management
A case of early interferonopathy in a child using modern recommendations for their management
Modern Pediatrics. Ukraine. (2023). 6(134): 24-35. doi 10.15574/SP.2023.134.24
Oshlіanska O. A.1, Okhotnikova O. M.1, Usova O. I.1, Gedeon I. V.2
1Shupyk National University of Health Care of Ukraine, Kyiv, Ukraine
2National Children's Specialised Hospital "OKHMATDYT", Kyiv, Ukraine
For citation: Oshlіanska OA, Okhotnikova OM, Usova OI, Gedeon IV. (2023). A case of early interferonopathy in a child using modern recommendations for their management. Modern Pediatrics. Ukraine. 6(134): 24-35. doi 10.15574/SP.2023.134.24.
Article received: Jul 11, 2023. Accepted for publication: Oct 10, 2023.
The article presents data from the scientific literature about the etiology, pathogenesis, and clinical manifestations of a recently discovered disease – childhood-onset STING-associated vasculopathy (SAVI), which is a genetically determined type I interferonopathy, and it clinically manifestes by a symptom complex of acral ischemia (lupus-like chilblain), interstitial lesions of the lungs and other pathologies of internal organs. SAVI more often manifests itself in the first months of a child’s life and passes under the guise of various autoimmune and infectious diseases. The article provides data on the differential diagnosis of SAVI, and emphasizes the importance of genetic testing for diagnosis. Considering the rarity of the pathology, the article includes a translation of the ACR recommendations (2021) regarding the treatment and observation of patients with interferonopathy. The article is illustrated by a description of a child with SAVI, whose diagnosis was carried out according to the principles proposed in these recommendations. The principles of follow-up of the child are described, the need for multidisciplinary management of patients with SAVI is emphasized. Current data on the prognosis and further course of the disease are provided.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
Keywords: children, interferonopathy, SAVI case, management.
REFERENCES
1. Chia J, Eroglu F, Ozen S et al. (2016). Failure to thrive, interstitial lung disease, and progressive digital necrosis with onset in infancy. J Am Acad Dermatol. 74 (1): 186-189. https://doi.org/10.1016/j.jaad.2015.10.007; PMid:26584874 PMCid:PMC4691417
2. Clarke SL, Pellowe EJ, de Jesus AA et al. (2016). Interstitial lung disease caused by STING-associated vasculopathy with onset in infancy. Am J Respir Crit Care Med. 194 (5): 639-642. https://doi.org/10.1164/rccm.201510-2102LE; PMid:27585386 PMCid:PMC5027210
3. Clarke SLN, Robertson L, Rice G et al. (2020). Type 1 interferonopathy presenting as juvenile idiopathic arthritis with interstitial lung disease: report of a new phenotype. Pediatr Rheumatol Online J. 18 (1): 37. https://doi.org/10.1186/s12969-020-00425-w; PMid:32398023 PMCid:PMC7218611
4. Cooray S, Henderson R, Solebo A L, Ancliffe P, Eleftheriou D, Brogan PA. (2021). Retinal vasculopathy in STING-associated vasculitis of infancy (SAVI). Rheumatology (Oxford). 60: e351-353. https://doi.org/10.1093/rheumatology/keab297; PMid:33764368
5. Dai YF, Liu XY, Zhao ZP, He JX, Yin QQ. (2020). Stimulator of Interferon Genes-Associated Vasculopathy with Onset in Infancy: A Systematic Review of Case Reports. Front. Pediatr. 8: 577918. https://doi.org/10.3389/fped.2020.577918; PMid:33425809 PMCid:PMC7786402
6. De Greef A, Pierre G, Baeck M. (2022). Pandemic chilblains: Are they SARS-CoV-2-related or not? Clinical Immunology. 237: 108984. https://doi.org/10.1016/j.clim.2022.108984; PMid:35338000 PMCid:PMC8942450
7. De Jesus AА (ed). (2002). STING1 (NM_198282.4) sequence variants. URL: https://infevers.umai-montpellier.fr/web/search.php?n=24.
8. Du Y, Liu M, Nigrovic PA, Dedeoglu F, Lee PY. (2023, Mar). Biologics and JAK inhibitors for the treatment of monogenic systemic autoinflammatory diseases in children. J Allergy Clin Immunol. 151 (3): 607-618. Epub 2023 Jan 25. https://doi.org/10.1016/j.jaci.2022.12.816; PMid:36707349
9. Eleftheriou D et al. (2019). Genetic interpheronopathies. In: Hashkes Philip J, Laxer Ronald M, Simon Anna, editors. Textbook of autoinflammation. Cham Switzerland AG: Springer: 433-453.
10. Falcon S, Weinfurtner RJ, Mooney B, Niell BL. (2018). SAVI SCOUT® localization of breast lesions as a practical alternative to wires: Outcomes and suggestions for trouble-shooting. Clinical Imaging. 52: 280-286. https://doi.org/10.1016/j.clinimag.2018.07.008; PMid:30193186
11. Fremond ML, Hadchouel A, Berteloot L et al. (2021). Overview of STING-associated vasculopathy with onset in infancy (SAVI) among 21 patients. J Allergy Clin Immunol Pract. 9 (2): 803-818.e11.
12. Frémond ML, Rodero MP, Jeremiah N, Belot A, Jeziorski E, Duffy D et al. (2016). Efficacy of the Janus kinase 1/2 inhibitor ruxolitinib in the treatment of vasculopathy associated with TMEM173-activating mutations in 3 children. J Allergy Clin Immunol. 138: 1752-1755. https://doi.org/10.26226/morressier.57bc1755d462b80290b4d6b9; PMCid:PMC5325846
13. Ganeva M, Petrova G, Mihailova S et al. (2022). STING-associated vasculopathy with onset in infancy: the first case in Bulgaria and review of the literature, Biotechnology & Biotechnological Equipment. 36; 1: 773-781. https://www.tandfonline.com/loi/tbeq20. https://doi.org/10.1080/13102818.2022.2112909
14. Gedik KC, Lamot L, Romano M et al. (2022, May). The 2021 European Alliance of Associations for Rheumatology/American College of Rheumatology Points to Consider for Diagnosis and Management of Autoinflammatory Type I Interferonopathies: CANDLE/PRAAS, SAVI, and AGS. Arthritis & Rheumatology. 74; 5: 735-751. https://doi.org/10.1002/art.42087; PMid:35315249
15. Ishikawa T, Tamura E, Kasahara M, Uchida H, Higuchi M, Kobayashi H et al. (2021). Severe liver disorder following liver transplantation in STING-associated vasculopathy with onset in infancy. J Clin Immunol. 41: 967-974. https://doi.org/10.1007/s10875-021-00977-w; PMid:33544357
16. Jain A, Misra DP, Sharma A, Wakhlu A, Agarwal V, Negi VS. (2018). Vasculitis and vasculitis-like manifestations in monogenic autoinflammatory syndromes [review]. Rheumatol Int. 38: 13-24. https://doi.org/10.1007/s00296-017-3839-6; PMid:29032440
17. Jeremiah N, Neven B, Gentili M, Callebaut I, Maschalidi S, Stolzenberg MC et al. (2014). Inherited STING-activating mutation underlies a familial inflammatory syndrome with lupus-like manifestations. J Clin Invest. 124: 5516-5520. https://doi.org/10.1172/JCI79100; PMid:25401470 PMCid:PMC4348945
18. Kim H, Brooks KM, Tang CC, Wakim P, Blake M, Brooks SR et al. (2018). Pharmacokinetics, pharmacodynamics, and proposed dosing of the oral JAK1 and JAK2 inhibitor baricitinib in pediatric and young adult CANDLE and SAVI patients. Clin Pharmacol Ther. 104: 364-373. https://doi.org/10.1002/cpt.936; PMid:29134648 PMCid:PMC6089664
19. Kim H, de Jesus AA, Brooks SR et al. (2018). J Interferon Cytokine Res. 38: 171-185. https://doi.org/10.1089/jir.2017.0127; PMid:29638206 PMCid:PMC5963606
20. Kim H, de Jesus AA, Brooks SR, Liu Y, Huang Y, VanTries R et al. (2018). Development of a validated interferon score using NanoString technology. J Interferon Cytokine Res. 38: 171-185. https://doi.org/10.1089/jir.2017.0127; PMid:29638206 PMCid:PMC5963606
21. Konig N, Fiehn C, Wolf C et al. (2017). Familial chilblain lupus due to a gain-of-function mutation in STING. Ann Rheum Dis. 76 (2): 468-472. https://doi.org/10.1136/annrheumdis-2016-209841; PMid:27566796
22. Li J, An S, Du Z. (2020). Familial interstitial lung disease caused by mutation of the STING1 gene. Front Pediatr. 8: 543. https://doi.org/10.3389/fped.2020.00543; PMid:33014937 PMCid:PMC7505928
23. Lin B, Berard R, Al Rasheed A et al. (2020). A novel STING1 variant causes a recessive form of STING-associated vasculopathy with onset in infancy (SAVI). J Allergy Clin Immunol. 146: 1204-1208.e6. https://doi.org/10.1016/j.jaci.2020.06.032; PMid:32673614 PMCid:PMC8461559
24. Lin B, Berard R, Al Rasheed A, Aladba B, Kranzusch PJ, Henderlight M et al. (2020). A novel STING1 variant causes a recessive form of STING associated vasculopathy with onset in infancy (SAVI). J Allergy Clin Immunol. 146: 1204-1248. https://doi.org/10.1016/j.jaci.2020.06.032; PMid:32673614 PMCid:PMC8461559
25. Liu Y, Jesus AA, Marrero B et al. (2014). Activated STING in a vascular and pulmonary syndrome. N Engl J Med. 371 (6): 507-518. https://doi.org/10.1056/NEJMoa1312625; PMid:25029335 PMCid:PMC4174543
26. Molaee H, Emadi SN, M Imunya JMN, Davoudi-Monfared E, Mohammed A, Razavi Z. (2022, Mar). Chilblain or perniosis-like skin lesions in children during the COVID-19 pandemic: A systematic review of articles. Dermatol Ther. 35 (3): e15298. Epub 2022 Jan 25. https://doi.org/10.1111/dth.15298; PMid:34981615
27. Munoz J, Rodiere M, Jeremiah N et al. (2015). Stimulator of interferon genes-associated vasculopathy with onset in infancy: a mimic of childhood granulomatosis with polyangiitis. JAMA Dermatol. 151 (8): 872-877. https://doi.org/10.1001/jamadermatol.2015.0251; PMid:25992765
28. Paparella R, Tarani L, Properzi E et al. (2022). Chilblain‑like lesions onset during SARS‑CoV‑2 infection in a COVID‑19‑vaccinated adolescent: case report and review of literature. Italian Journal of Pediatrics. 48: 93. https://doi.org/10.1186/s13052-022-01296-5; PMid:35698236 PMCid:PMC9190458
29. Picard C, Thouvenin G, Kannengiesser C, Dubus JC, Jeremiah N, Rieux-Laucat F et al. (2016). Severe pulmonary fibrosis as the first manifestation of Interferonopathy (TMEM173 mutation). Chest. 150: e65-71. https://doi.org/10.1016/j.chest.2016.02.682; PMid:27613991
30. Raffaele CGL, Messia V, Moneta G et al. (2020). A patient with stimulator of interferon genes-associated vasculopathy with onset in infancy without skin vasculopathy. Rheumatology (Oxford). 59 (4): 905-907. https://doi.org/10.1093/rheumatology/kez444; PMid:31598716
31. Runnblom L, Leonard D. (2019). Interferon pathway in SLE: one key to unlocking the mystery of the disease. Lupus Science & Medicine. 6: e000270. https://doi.org/10.1136/lupus-2018-000270; PMid:31497305 PMCid:PMC6703304
32. Saldanha RG, Balka KR, Davidson S et al. (2018). A mutation outside the dimerizati on domain causing atypical STING-associated vasculopathy with onset in infancy. Front Immunol. 9: 1535. https://doi.org/10.3389/fimmu.2018.01535; PMid:30038614 PMCid:PMC6047589
33. Sanchez GA, Reinhardt A, Ramsey S, Wittkowski H, Hashkes PJ, Berkun Y et al. (2018). JAK1/2 inhibition with baricitinib in the treatment of autoinflammatory interferonopathies. J Clin Invest. 128: 3041-3052. https://doi.org/10.1172/JCI98814; PMid:29649002 PMCid:PMC6026004
34. Sawires R, Pearce C, Fahey M et al. (2022). COVID-toes: An ecological study of chilblains and COVID-19 diagnoses in Victoria, Australia. PLOS Glob Public Health. 2 (10): e0000488. https://doi.org/10.1371/journal.pgph.0000488; PMid:36962522 PMCid:PMC10022016
35. Sönmez HE, Karaaslan C, de Jesus AA, Batu ED, Anlar B, Sözeri B et al. (2020). A clinical score to guide in decision making for monogenic type IFNopathies. Pediatr Res. 87: 745-752. https://doi.org/10.1038/s41390-019-0614-2; PMid:31641281 PMCid:PMC8425764
36. Starkey SY, Mar K, Kashetsky N. (2022, Nov 18). Chilblain-like lesions coinciding with the SARS-CoV-2 pandemic. Clinics in Dermatology. 18: 33. https://doi.org/10.1016/j.clindermatol.2022.09.010; PMid:36228990 PMCid:PMC9551125
37. Tang X, Xu H, Zhou C, Peng Y, Liu H, Liu J et al. (2020). STING-associated vasculopathy with onset in infancy in three children with new clinical aspect and unsatisfactory therapeutic responses to tofacitinib. J Clin Immunol. 40: 114-122. https://doi.org/10.1007/s10875-019-00690-9; PMid:31705453
38. Tokgun PE, Karagenc N, Karasu Uğ. (2023). Treatment of STING-associated vasculopathy with onset in infancy in patients carrying a novel mutation in the TMEM173 gene with the JAK3-inhibitor tofacitinib. Arch Rheumatol. 38 (x): I-VII. https://doi.org/10.46497/ArchRheumatol.2023.9927; PMid:38046254 PMCid:PMC10689023
39. Torreggiani S, Alehashemi S, Mitchell J. (2020). Clinical Features and Outcomes in STING-Associated Vasculopathy with Onset in Infancy (SAVI) ACR Convergence. Abstrac1234567890Ct number: 1158. URL: https://acrabstracts.org/abstract/clinical-features-and-outcomes-in-sting-associated-vasculopathy-with-onset-in-infancy-savi/.
40. Vanderver A, Prust M, Kadom N, Demarest S, Crow YJ, Helman G et al. (2015). Early-onset Aicardi-Goutières syndrome: magnetic resonance imaging (MRI) pattern recognition. J Child Neurol. 30: 1343-1348. https://doi.org/10.1177/0883073814562252; PMid:25535058 PMCid:PMC4476968
41. Volpi S, Insalaco A, Caorsi R. (2019). Efficacy and Adverse Events During Janus Kinase Inhibitor Treatment of SAVI Syndrome. Journal of Clinical Immunology. 39: 476-485. https://doi.org/10.1007/s10875-019-00645-0; PMid:31144250 PMCid:PMC7086512
42. Wang Y, Wang F, Zhang X. (2021). STING-associated vasculopathy with onset in infancy: a familial case series report and literature review. Ann Transl Med. 9 (2): 176. https://doi.org/10.21037/atm-20-6198; PMid:33569478 PMCid:PMC7867893
