Enteroviral meningoencephalitis as a complication of X-linked hyper IgM syndrome.
We describe 5 children from 2 families with mutations in the CD40 ligand (CD40L) gene leading to absent expression of CD40L on activated CD4 cells. All subjects presented with interstitial pneumonia with low serum IgG and normal serum IgM. One child had normal and one child had elevated serum IgA. Four had confirmed Pneumocystis carinii pneumonia. In spite of intravenous immunoglobulin treatment yielding therapeutic serum immunoglobulin levels, 3 children had enteroviral encephalitis. When assessed by flow cytometry, the 3 surviving affected male children had absent CD40L expression on activated CD4(+) T cells. The affected children from both families were shown to have the same single nucleotide insertion (codon 131) resulting in frameshift and early termination within exon 4 (extracellular domain). This observation demonstrates that persistent enteroviral infection is not only observed in X-linked agammaglobulinemia but may also occur in patients with X-linked hyper IgM syndrome.
Cunningham
C K
CK
Departments of Pediatrics and Pathology, State University of New York Health Science Center at Syracuse, New York, MD, USA.
Bonville
C A
CA
Ochs
H D
HD
Seyama
K
K
John
P A
PA
Rotbart
H A
HA
Weiner
L B
LB
D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D019013:CD40 Antigens / Q000276:immunology*; D023201:CD40 Ligand; D004252:DNA Mutational Analysis; D004769:Enterovirus Infections / Q000209:etiology*; D005434:Flow Cytometry; D008040:Genetic Linkage; D006801:Humans; D006942:Hypergammaglobulinemia / Q000150:complications* / Q000235:genetics* / Q000628:therapy; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007223:Infant; D008024:Ligands; D008213:Lymphocyte Activation; D008297:Male; D008562:Membrane Glycoproteins / Q000235:genetics*; D008590:Meningoencephalitis / Q000209:etiology*; D009154:Mutation; D010375:Pedigree; D011020:Pneumonia, Pneumocystis / Q000150:complications; D016133:Polymerase Chain Reaction; D013577:Syndrome; D014960:X Chromosome
D019013:CD40 Antigens; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D016756:Immunoglobulins, Intravenous; D008024:Ligands; D008562:Membrane Glycoproteins; D023201:CD40 Ligand