Wiskott–Aldrich syndrome presenting with a clinical picture mimicking juvenile myelomonocytic leukaemia1. Issue 5 (28th September 2012)

• Record Type: Journal Article
• Authors: Yoshimi, Ayami; Kamachi, Yoshiro; Imai, Kosuke; Watanabe, Nobuhiro; Nakadate, Hisaya; Kanazawa, Takashi; Ozono, Shuichi; Kobayashi, Ryoji; Yoshida, Misa; Kobayashi, Chie; Hama, Asahito; Muramatsu, Hideki; Sasahara, Yoji; Jakob, Marcus; Morio, Tomohiro; Ehl, Stephan; Manabe, Atsushi; Niemeyer, Charlotte; Kojima, Seiji
• Is Part Of: Pediatric blood & cancer. Volume 60:Issue 5(2013:May)
• Page Start: 836
• Page End: 841
• Publication Date: 2012-09-28
• Subjects: Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Cancer in children -- Periodicals; 618.92
• DOI: 10.1002/pbc.24359
• Languages: English
• ISSNs: 1545-5009

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="abs1-1" sec-type="section"> <title>Background</title> <p>Wiskott–Aldrich syndrome (WAS) is a rare X‐linked immunodeficiency caused by defects of the WAS protein (<italic>WASP</italic>) gene. Patients with WAS typically demonstrate micro‐thrombocytopenia.</p> </sec> <sec id="abs1-2" sec-type="section"> <title>Procedures</title> <p>The report describes seven male infants with WAS that initially presented with leukocytosis, monocytosis, and myeloid and erythroid precursors in the peripheral blood (PB) and dysplasia in the bone marrow (BM), which was initially indistinguishable from juvenile myelomonocytic leukaemia (JMML).</p> </sec> <sec id="abs1-3" sec-type="section"> <title>Results</title> <p>The median age of affected patients was 1 month (range, 1–4 months). Splenomegaly was absent in four of these patients, which was unusual for JMML. A mutation analysis of genes in the RAS‐signalling pathway did not support a diagnosis of JMML. Non‐haematological features, such as eczema (n = 7) and bloody stools (n = 6), ultimately led to the diagnosis of WAS at a median age of 4 months (range, 3–8 months), which was confirmed by absent (n = 6) or reduced (n = 1) WASP expression in lymphocytes by flow cytometry (FCM) and a <italic>WASP</italic> gene mutation. Interestingly, mean platelet volume (MPV) was normal in three of five patients and six of seven patients demonstrated occasional giant platelets, which was not compatible with WAS.</p> </sec> <sec id="abs1-4" sec-type="section"> <title>Conclusions</title> <p>These data suggest that WAS should be considered in male infants presenting with JMML‐like features if no molecular markers of JMML can be detected. Pediatr Blood Cancer 2013; 60: 836–841. © 2012 Wiley Periodicals, Inc.</p> </sec> </abstract>