title: Hereditary C2 deficiency in Sweden: frequent occurrence of invasive infection, atherosclerosis, and rheumatic disease.
abstract: Although frequently asymptomatic, homozygous C2 deficiency (C2D) is known to be associated with severe infections and rheumatic disease. We describe the clinical findings in 40 persons with C2D from 33 families identified in Sweden over 25 years. Medical records covering 96% of the accumulated person-years were reviewed, giving a mean observation time of 39 years (range, 1-77 yr). Severe infection was the predominant clinical manifestation in the cohort: 23 patients had a past history of invasive infections, mainly septicemia or meningitis caused by Streptococcus pneumoniae, and 12 patients had repeated infections of this kind. Nineteen patients had at least 1 episode of pneumonia, and recurrent pneumonia was documented in 10 patients. Repeated infections occurred mainly during infancy and childhood. Systemic lupus erythematosus was found in 10 patients. Another 7 patients had undifferentiated connective tissue disease (n = 4) or vasculitis (n = 3). We found no correlation between susceptibility to invasive infection and rheumatologic disease. Cardiovascular disease occurred at a high rate, with a total of 10 acute myocardial infarctions and 5 cerebrovascular episodes in 6 patients. Causes of death among the C2D patients were infection (n = 5), acute myocardial infarction (n = 3), and cancer (n = 1). We suggest that severe infection may be the principal clinical manifestation of C2D. We also provide novel evidence for a possible role of C2D in the development of atherosclerosis consistent with findings in mannan-binding deficiency and experimental C3 deficiency. In addition, we confirm the well-known association between C2D and systemic lupus erythematosus.
authors.affiliation: From Department of Infectious Diseases (GJ, JHB), Department of Pediatrics (VO), and Department of Rheumatology (GS), University Hospital of Lund; and the Institute of Laboratory Medicine, Section of Microbiology, Immunology and Glycobiology (GJ, LT, AGS), Lund University, Lund, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Jönsson
authors.forename: Lennart
authors.initials: L
authors.lastname: Truedsson
authors.forename: Gunnar
authors.initials: G
authors.lastname: Sturfelt
authors.forename: Vivi-Anne
authors.initials: VA
authors.lastname: Oxelius
authors.forename: Jean Henrik
authors.initials: JH
authors.lastname: Braconier
authors.forename: Anders G
authors.initials: AG
authors.lastname: Sjöholm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003175:Complement C2 / Q000172:deficiency*; D005192:Family Health; D005260:Female; D006720:Homozygote; D006801:Humans; D007239:Infections / Q000453:epidemiology; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology
chemical_list: D003175:Complement C2