| Autoinflammation and PLCG2-associated antibody deficiency and immune dysregulation (APLAID) is an autosomal dominant autoinflammatory disease characterized by episodic skin, musculoskeletal, ophthalmic and
gastrointestinal tract symptoms. Here we report an 11-year-old girl with a history of repeated episodes of fever,
myalgia, arthralgia, abdominal pain, and urticarial rash in the trunk and limbs. Chest and pelvic X-Ray, sacroiliac joints MRI, brain MRI and abdominal CT scan were normal. Anti-nuclear antibody, Rheumatoid factor,
cryoglobulin, ANCA/PR3, p-ANCA/MPO, anti-smooth muscle antibody and anti-mitochondrial antibody were
negative. Serology for cytomegalovirus, Epstein-Barr, hepatitis B, hepatitis C, and HIV viruses was negative.
Serum immunoglobulins were in the normal range. Genetic analysis for familial Mediterranean fever syndrome
was negative. Whole exome sequencing was carried out to identify the genetic cause of our patient. We identified
a homozygous missense variant (c.579C > G, p. His193Gln) in exon 7 of the PLCG2 gene. Bioinformatic analysis
and clinical symptoms suggests this variant to be pathogenic in the homozygous state for APLAID and thus
probably acting in an autosomal recessive manner. Our bioinformatic analysis also showed this novel mutation
to have detrimental effects on the 3D structure of the PLCG2 protein, which is well conserved among many other
similar species. |