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514 The Autoimmune Lymphoproliferative Syndrome: A Case Report
  1. L Sfaihi1,
  2. S Kmiha1,
  3. I Maaloul1,
  4. I Ben Mustapha2,
  5. R Barbouch2,
  6. M Hachicha1
  1. 1CHU Hedi Chaker, Sfax
  2. 2Institut Pasteur, Tunis, Tunisia

Abstract

Background The Autoimmune Lymphoproliferative Syndrome (ALPS) is an impairment of lymphocyte apoptosis expressed by generalized non-malignant lymphoproliferation, lymphadenopathy and/or splenomegaly. Majority of patients with ALPS harbor heterozygous germline mutations in the gene for the TNF receptor-family member Fas (CD 95, Apo-1) which are inherited in an autosomal dominant fashion. Somatic Fas mutations are the second most common genetic etiology of ALPS.

Case report We describe a two year old boy who was admitted with hepatosplenomegaly, generalized lymphadenopathy and anemia. Histopathological and immunohistochemical analysis of lymph nodes suggested a lymphoproliferative disorder in large granular lymphocytes. The lymphocyte phenotyping performed in the patient showed an increased population of T cells αβ double negative (LTCD3+ TCR αβ+ CD4- CD8-) about 27% (control < 2.5%). The study of FAS gene allowed the identification of a mutation in exon 9.

Conclusion ALPS is an underestimated entity that must be considered in non malign lymphoproliferation, autoimmunity and expansion of an unusual population of a/ß CD3+CD4-CD8- (double-negative T cells>1%).

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