Aggiornamento
Difetto di mevalonato-chinasi: molte facce di una stessa malattia
Mevalonate kinase deficiency: various aspects of the same disease
Carlo De Pieri1, Antonella Insalaco2, Andrea Taddio >sup>1>/sup>, Egidio Barbi1, Loredana Lepore1, Alberto Tommasini1, Alessandro Ventura1
1IRCCS Materno-Infantile Burlo Garofolo, Trieste
2IRCCS Ospedale Pediatrico Bambino Ges, Roma
Ottobre 2013 - pagg. 501 -506
Abstract
Mevalonate kinase deficiency (MKD), also known as Hyper IgD syndrome, is an inborn
error of metabolism characterized by inflammatory dysregulation and, in most severe
cases, neurodevelopmental delay. The clinical phenotype of each patient depends on
the severity of the underlying enzymatic defect and on environmental factors. Due to its
complex pathogenesis, involving both metabolic and immune functions, the disease
shows different clinical pictures mimicking infectious, inflammatory, rheumatologic and
neurological disorders. In these cases the correct diagnosis may be delayed and the patient
may undergo useless investigation and treatment. In the present work five common
patterns of clinical presentation of the disease that can lead to a late or wrong diagnosis
are identified. Considering MKD as a novel great mimicker can foster awareness
of this disorder among paediatricians and physicians in different medical specialties.
Each case will enable to discuss possible diagnostic pitfalls and to propose practical
hints to improve the diagnosis.
Classificazione MeSH
Contenuto riservato
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Bibliografia
1. Simon A, Kremer HP, Wevers RA, et al. Mevalonate
kinase deficiency: Evidence for a phenotypic
continuum. Neurology 2004;62:994-7.
2. Mandey SH, Schneiders MS, Koster J, Waterham
HR. Mutational spectrum and genotype-
phenotype correlations in mevalonate kinase
deficiency. Hum Mutat 2006;27:796-802.
3. Drenth JP, Haagsma CJ, van der Meer JW.
Hyperimmunoglobulinemia D and periodic fever
syndrome. The clinical spectrum in a series
of 50 patients. International Hyper-IgD Study
Group. Medicine (Baltimore)1994;73: 133-44.
4. van der Hilst JC, Bodar EJ, Barron KS, et
al.; International HIDS Study Group. Longterm
follow-up, clinical features, and quality of
life in a series of 103 patients with hyperimmunoglobulinemia
D syndrome. Medicine
(Baltimore) 2008;87:301-10.
5. Hoffmann GF, Charpentier C, Mayatepek
E, et al. Clinical and biochemical phenotype in
11 patients with mevalonic aciduria. Pediatrics
1993;91:915-21.
6. van der Meer JW, Vossen JM, Radl J, et al.
Hyperimmunoglobulinaemia D and periodic
fever: a new syndrome. Lancet 1984;1:1087-90.
7. Klasen IS, Goertz JH, van de Wiel GA, Weemaes
CM, van der Meer JW, Drenth JP. Hyper-
immunoglobulin A in the hyperimmunoglobulinemia
D syndrome. Clin Diagn Lab Immunol
2001;8:58-61.
8. Gattorno M, Sormani MP, DOsualdo A, et
al. A diagnostic score for molecular analysis
of hereditary autoinflammatory syndromes
with periodic fever in children. Arthritis
Rheum 2008;58:1823-32.
9. Steiner LA, Ehrenkranz RA, Peterec SM,
Steiner RD, Reyes-Mugica M, Gallagher PG.
Perinatal onset mevalonate kinase deficiency.
Pediatr Dev Pathol 2011;14:301-6.
10. Rigante D, Capoluongo E, Bertoni B, et al.
First report of macrophage activation syndrome
in hyperimmunoglobulinemia D with periodic
fever syndrome. Arthritis Rheum 2007;
56:658-61.
11. Marchetti F, Barbi E, Tommasini A, Oretti
C, Ventura A. Inefficacy of etanercept in a
child with hyper-IgD syndrome and periodic
fever. Clin Exp Rheumatol 2004;22:791-2.
12. Oretti C, Barbi E, Marchetti F, et al. Diagnostic
challenge of hyper-IgD syndrome in
four children with inflammatory gastrointestinal
complaints. Scand J Gastroenterol 2006;
41:430-6.
13. Haas D, Hoffmann GF. Mevalonate kinase
deficiencies: from mevalonic aciduria to hyperimmunoglobulinemia
D syndrome. Orphanet
J Rare Dis 2006;1:13.
14. Nevyjel M, Pontillo A, Calligaris L, et al.
Diagnostics and therapeutic insights in a severe
case of mevalonate kinase deficiency. Pediatrics
2007;119:e523-7.
15. Bader-Meunier B, Florkin B, Sibilia J, et
al. Mevalonate kinase deficiency: a survey of
50 patients. Pediatrics 2011;128:e152-9.
16. DOsualdo A, Picco P, Caroli F, et al. MVK
mutations and associated clinical features in
Italian patients affected with autoinflammatory
disorders and recurrent fever. Eur J Hum
Genet 2005;13:314-20.
17. Houten SM, van Woerden CS, Wijburg FA,
Wanders RJ, Waterham HR. Carrier frequency
of the V377I (1129G>A) MVK mutation,
associated with Hyper-IgD and periodic
fever syndrome, in the Netherlands. Eur J
Hum Genet 2003;11:196-200.
18. Marcuzzi A, Pontillo A, De Leo L, et al. Natural
isoprenoids are able to reduce inflammation
in a mouse model of mevalonate kinase
deficiency. Pediatr Res 2008;64:177-82.
19. Cailliez M, Garaix F, Rousset-Rouviere C,
et al. Anakinra is safe and effective in controlling
hyperimmunoglobulinaemia D syndrome-
associated febrile crisis. J Inherit Metab
Dis 2006;29:763.
20. Rigante D, Ansuini V, Bertoni B, et al.
Treatment with anakinra in the hyperimmunoglobulinemia
D/periodic fever syndrome.
Rheumatol Int 2006;27:97-100.
21. Bodar EJ, van der Hilst JC, Drenth JP, van
der Meer JW, Simon A. Effect of etanercept
and anakinra on inflammatory attacks in the
hyper-IgD syndrome: introducing a vaccination
provocation model. Neth J Med 2005;63:
260-4.
22. Chaudhury S, Hormaza L, Mohammad S,
et al. Liver transplantation followed by allogeneic
hematopoietic stem cell transplantation
for atypical mevalonic aciduria. Am J Transplant
2012;12:1627-31.
23. Neven B, Valayannopoulos V, Quartier P, et
al. Allogeneic bone marrow transplantation in
mevalonic aciduria. N Engl J Med 2007;356:
2700-3.
24. Haas D, Kelley RI, Hoffmann GF. Inherited
disorders of cholesterol biosynthesis.
Neuropediatrics 2001;32:113-22.
Corrispondenza: carlodepieri@gmail.com
