Precision treatment of Singleton Merten syndrome with ruxolitinib: a case report
Research output: Contribution to journal › Case report › Contributed › peer-review
Contributors
Abstract
Background: Singleton-Merten syndrome 1 (SGMRT1) is a rare type I interferonopathy caused by heterozygous mutations in the IFIH1 gene. IFIH1 encodes the pattern recognition receptor MDA5 which senses viral dsRNA and activates antiviral type I interferon (IFN) signaling. In SGMRT1, IFIH1 mutations confer a gain-of-function which causes overactivation of type I interferon (IFN) signaling leading to autoinflammation. Case presentation: We report the case of a nine year old child who initially presented with a slowly progressive decline of gross motor skill development and muscular weakness. At the age of five years, he developed osteoporosis, acro-osteolysis, alveolar bone loss and severe psoriasis. Whole exome sequencing revealed a pathogenic de novo IFIH1 mutation, confirming the diagnosis of SGMRT1. Consistent with constitutive type I interferon activation, patient blood cells exhibited a strong IFN signature as shown by marked up-regulation of IFN-stimulated genes. The patient was started on the Janus kinase (JAK) inhibitor, ruxolitinib, which inhibits signaling at the IFN-α/β receptor. Within days of treatment, psoriatic skin lesions resolved completely and the IFN signature normalized. Therapeutic efficacy was sustained and over the course muscular weakness, osteopenia and growth also improved. Conclusions: JAK inhibition represents a valuable therapeutic option for patients with SGMRT1. Our findings also highlight the potential of a patient-tailored therapeutic approach based on pathogenetic insight.
Details
Original language | English |
---|---|
Article number | 24 |
Journal | Pediatric Rheumatology |
Volume | 20 |
Issue number | 1 |
Publication status | Published - Dec 2022 |
Peer-reviewed | Yes |
External IDs
PubMed | 35410415 |
---|
Keywords
ASJC Scopus subject areas
Keywords
- Auto inflammation, Autoimmunity, Janus kinase inhibitor, Ruxolitinib, Singleton Merten syndrome, Therapy, Type I interferon