TNF receptor-associated periodic syndrome (TRAPS): description of a novel TNFRSF1A mutation and response to etanercept.
TRAPS is the most common of the autosomal dominant periodic fever syndromes. It is caused by mutations in the TNFRSF1A gene, which encodes for the type 1 TNF-receptor (TNFR1). We describe here a Brazilian patient with TRAPS associated to a novel TNFRSF1A de novo mutation and the response to anti-TNF therapy. The patient is a 9-year-old girl with recurrent fevers since the age of 3 years, usually lasting 3 to 7 days, and recurring every other week. These episodes are associated with mild abdominal pain, nausea, vomiting and generalized myalgia. Recurrent conjunctivitis and erysipela-like skin lesions in the lower limbs also occur. Laboratory studies show persistent normocytic normochromic anemia, thrombocytosis, elevated erythrocyte sedimentation rate and C-reactive protein. IgD levels are normal. Mutational screening of TNFRSF1A revealed the association of a novel C30F mutation with the common R92Q low-penetrance mutation. The R92Q mutation is seen in 5% of the general population and is associated with an atypical inflammatory phenotype. The patient had a very good response to etanercept, with cessation of fever and normalization of inflammatory markers. Our report expands the spectrum of TNFRSF1A mutations associated with TRAPS, adding further evidence for possible additive effects of a low-penetration R92Q and cysteine residue mutations, and confirms etanercept as an efficacious treatment alternative.
Jesus
Adriana A
AA
Pediatric Rheumatology Unit, Pediatrics Department, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 647, 05403-900, São Paulo, SP, Brazil.
Oliveira
João B
JB
Aksentijevich
Ivona
I
Fujihira
Erika
E
Carneiro-Sampaio
Magda M S
MM
Duarte
Alberto J S
AJ
Silva
Clovis A A
CA
D015746:Abdominal Pain / Q000235:genetics; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018771:Arthralgia / Q000235:genetics; D002648:Child; D003231:Conjunctivitis / Q000235:genetics; D004890:Erythema / Q000235:genetics; D000068800:Etanercept; D010505:Familial Mediterranean Fever / Q000188:drug therapy* / Q000235:genetics*; D005260:Female; D005819:Genetic Markers; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D020125:Mutation, Missense; D009325:Nausea / Q000235:genetics; D010375:Pedigree; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood / Q000627:therapeutic use*; D047888:Receptors, Tumor Necrosis Factor, Type I / Q000097:blood / Q000235:genetics*; D016896:Treatment Outcome; D014839:Vomiting / Q000235:genetics
D000894:Anti-Inflammatory Agents, Non-Steroidal; D005819:Genetic Markers; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D047888:Receptors, Tumor Necrosis Factor, Type I; C506235:TNFRSF1A protein, human; D000068800:Etanercept