title: Additional diverse findings expand the clinical presentation of DOCK8 deficiency.
abstract: We describe seven Turkish children with DOCK8 deficiency who have not been previously reported. Three patients presented with typical features of recurrent or severe cutaneous viral infections, atopic dermatitis, and recurrent respiratory or gastrointestinal tract infections. However, four patients presented with other features. Patient 1-1 featured sclerosing cholangitis and colitis; patient 2-1, granulomatous soft tissue lesion and central nervous system involvement, with primary central nervous system lymphoma found on follow-up; patient 3-1, a fatal metastatic leiomyosarcoma; and patient 4-2 showed no other symptoms initially besides atopic dermatitis. Similar to other previously reported Turkish patients, but in contrast to patients of non-Turkish ethnicity, the patients' lymphopenia was primarily restricted to CD4(+) T cells. Patients had homozygous mutations in DOCK8 that altered splicing, introduced premature terminations, destabilized protein, or involved large deletions within the gene. Genotyping of remaining family members showed that DOCK8 deficiency is a fully penetrant, autosomal recessive disease. In our patients, bone marrow transplantation resulted in rapid improvement followed by disappearance of viral skin lesions, including lesions resembling epidermodysplasia verruciformis, atopic dermatitis, and recurrent infections. Particularly for patients who feature unusual clinical manifestations, immunological testing, in conjunction with genetic testing, can prove invaluable in diagnosing DOCK8 deficiency and providing potentially curative treatment.
authors.affiliation: Department of Pediatric Immunology, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey. sanaloz@tr.net
authors.forename: Ozden
authors.initials: O
authors.lastname: Sanal
authors.forename: Huie
authors.initials: H
authors.lastname: Jing
authors.forename: Tuba
authors.initials: T
authors.lastname: Ozgur
authors.forename: Deniz
authors.initials: D
authors.lastname: Ayvaz
authors.forename: Dara M
authors.initials: DM
authors.lastname: Strauss-Albee
authors.forename: Sibel
authors.initials: S
authors.lastname: Ersoy-Evans
authors.forename: Ilhan
authors.initials: I
authors.lastname: Tezcan
authors.forename: Gulten
authors.initials: G
authors.lastname: Turkkani
authors.forename: Helen F
authors.initials: HF
authors.lastname: Matthews
authors.forename: Goknur
authors.initials: G
authors.lastname: Haliloglu
authors.forename: Aysel
authors.initials: A
authors.lastname: Yuce
authors.forename: Bilgehan
authors.initials: B
authors.lastname: Yalcin
authors.forename: Ozay
authors.initials: O
authors.lastname: Gokoz
authors.forename: Kader K
authors.initials: KK
authors.lastname: Oguz
authors.forename: Helen C
authors.initials: HC
authors.lastname: Su
mesh_terms: D000293:Adolescent; D016026:Bone Marrow Transplantation; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000235:genetics; D005260:Female; D005838:Genotype; D020662:Guanine Nucleotide Exchange Factors / Q000172:deficiency* / Q000235:genetics*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008231:Lymphopenia / Q000235:genetics / Q000628:therapy; D008297:Male; D017384:Sequence Deletion; D016511:Severe Combined Immunodeficiency / Q000235:genetics* / Q000276:immunology / Q000628:therapy; D014421:Turkey
chemical_list: C516591:DOCK8 protein, human; D020662:Guanine Nucleotide Exchange Factors; D016756:Immunoglobulins, Intravenous