以全血细胞减少为主要表现的腺苷脱氨酶2缺乏症一例

A Case Report of Clinical Characteristics of Deficiency of Adenosine Deaminase 2 with Pancytopenia

  • 摘要: 腺苷脱氨酶2缺乏症(DADA2)是一类由于ADA2基因变异引起的单基因自身炎症性疾病,该病临床表现复杂,其血液系统受累表现罕见,临床易误诊、漏诊。本研究报道北京协和医院收治的1例DADA2患儿以再生障碍性贫血起病,经糖皮质激素、环孢素及多种对症支持治疗后效果欠佳,后出现全血细胞减少,行基因检测提示ADA2基因新发纯合变异(NM_001282225.2: c.712_750dupGACAACGTGCTCTACATGGAGATCAGAGCCAGGCTGCTG),外周血ADA2水平减低,结合临床表现诊断为DADA2。基因检测及监测ADA2水平有助于DADA2早期诊断。依据疾病表型和严重程度,治疗方案包括糖皮质激素、免疫抑制剂、生物制剂和造血干细胞移植等。

     

    Abstract: Deficiency of adenosine deaminase 2(DADA2) is a rare monogenic autoinflammatory disorder caused by genetic variations in the ADA2 gene. The disease has complex clinical manifestations. The hematological involvement is infrequent in the disease. Therefore, the disease is frequently wrongly diagnosed and missed diagnoses. This article reports a case of a child patient with DADA2 who was admitted to the Peking Union Medical College Hospital. The child had aplastic anemia. After inadequate response to treatment with glucocorticoids, cyclosporine, and various supportive measures, the patient exhibited pancytopenia. Genetic testing showed a novel homozygous mutation in the ADA2 gene (NM_001282225.2:c.712_750dupGACAACGTGCTCTACATGGAGATCAGAGCCAGGCTGCTG), with reduced ADA2 levels in peripheral blood. Based on the testing results and clinical manifestations, the patient was diagnosed DADA2. Genetic testing and monitoring of ADA2 levels proved helpful in the early diagnosis of DADA2. Treatment protocol should base on the disease phenotype and severity, and include glucocorticoids, immunosuppressants, biological agents, and hematopoietic stem cell transplantation.

     

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