背景:血液恶性肿瘤一直是科学家的挑战,因为不断需要更好地定义这些实体。骨髓增生异常综合征(MDS)是以无效造血为特征的克隆造血疾病。细胞遗传学和分子发现是这些综合征的先决条件,因为它们证实了疾病的克隆性质。然而,作为其发病机理的一部分,MDS通常与自身免疫和炎症有关。最近,VEXAS综合征(空泡,E1酶,X-linked,自身炎症,体细胞)在单个突变中连接了这两个,这表明血液恶性肿瘤之间的异质性通常需要通过根据每个患者的个体特征定制药物治疗来进行更个性化的治疗。
方法:我们介绍了一例VEXAS综合征,一例63岁男性患者最初出现低热发作,膝盖和脚踝的多关节炎,多肌痛,和疲劳。他的实验室检查显示血清炎症标志物水平升高。
方法:诊断基于高度临床怀疑,实验室发现,骨髓评估中红系和髓系前体的空泡化。泛素样修饰物激活酶1基因的突变状态为阳性,等位基因形态频率为68.8%(rs782416867)。
方法:治疗基于使用糖皮质激素控制炎症和使用促红细胞生成素治疗MDS相关贫血。
结果:目前,病人定期到我们科室就诊。他仍在接受上述治疗。他暂时没有提及任何新事件。
结论:VEXAS综合征作为一种新发现的实体,由于其临床表现明显多样化,因此常被低估。
BACKGROUND: Hematological malignancies have always been a challenge for scientists because there is a constant need to better define these entities. Myelodysplastic syndromes (MDS) are clonal hematopoietic disorders characterized by ineffective hematopoiesis. Cytogenetics and molecular findings are a prerequisite for these syndromes as they confirm the clonal nature of the disease. However, MDS is often linked to autoimmunity and inflammation as part of its pathogenesis. Recently, VEXAS syndrome (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) linked these two in a single mutation, suggesting that the heterogeneity among hematological malignancies often demands a more personalized medicine by tailoring medical treatment to the individual characteristics of each patient.
METHODS: We present a
case of VEXAS syndrome regarding a 63-year-old male patient who initially presented with episodes of low fever, polyarthritis of the knees and ankles, polymyalgia, and fatigue. His laboratory examinations revealed increased levels of serum inflammatory markers.
METHODS: Diagnosis was based on high clinical suspicion, laboratory findings, and vacuolization of the erythroid and myeloid precursors in the bone marrow evaluation. Mutational status of ubiquitin-like modifier activating enzyme 1 gene was positive with a 68.8% allelomorph frequency (rs782416867).
METHODS: Therapy was based on controlling inflammation with the use of glucocorticoids and treating MDS-related anemia with the use of erythropoietin.
RESULTS: Currently, the patient visits our department regularly. He is still receiving the aforementioned treatment. He did not mention any new incidents for the time being.
CONCLUSIONS: VEXAS syndrome as a newly identified entity might be often underestimated since its clinical presentation is notably diverse.