Skip to main content
Top
Published in: Journal of Medical Case Reports 1/2013

Open Access 01-12-2013 | Case report

A child with autoimmune polyendocrinopathy candidiasis and ectodermal dysplasia treated with immunosuppression: a case report

Authors: Clodagh S O’Gorman, Rayzel Shulman, Irene Lara-Corrales, Elena Pope, Margaret Marcon, Hartmut Grasemann, Rayfel Schneider, Julia Upton, Etienne B Sochett, Dror Koltin, Eyal Cohen

Published in: Journal of Medical Case Reports | Issue 1/2013

Login to get access

Abstract

Introduction

Common features of autoimmune polyendocrinopathy-candidiasis-ectodermal dysplasia include candidiasis, hypoparathyroidism and hypoadrenalism. The initial manifestation of autoimmune polyendocrinopathy-candidiasis-ectodermal dysplasia may be autoimmune hepatitis, keratoconjunctivitis, frequent fever with or without a rash, chronic diarrhea, or different combinations of these with or without oral candidiasis.

Case presentation

We discuss a profoundly affected 2.9-year-old Caucasian girl of Western European descent with a dramatic response to immunosuppression (initially azathioprine and oral steroids, and then subsequently mycophenolate mofetil monotherapy). At four years of follow-up, her response to mycophenolate mofetil is excellent.

Conclusion

The clinical features of autoimmune polyendocrinopathy-candidiasis-ectodermal dysplasia may continue for years before some of the more common components appear. In such cases, it may be life-saving to diagnose autoimmune polyendocrinopathy-candidiasis-ectodermal dysplasia and commence therapy with immunosuppressive agents. The response of our patient to immunosuppression with mycophenolate mofetil has been dramatic. It is possible that other patients with this condition might also benefit from immunosuppression.
Appendix
Available only for authorised users
Literature
1.
go back to reference Cheng MH, Shum AK, Anderson MS: What’s new in the Aire?. Trends Immunol. 2007, 28: 321-327. 10.1016/j.it.2007.05.004.CrossRefPubMed Cheng MH, Shum AK, Anderson MS: What’s new in the Aire?. Trends Immunol. 2007, 28: 321-327. 10.1016/j.it.2007.05.004.CrossRefPubMed
2.
go back to reference Perheentupa J: Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy. J Clin Endocrinol Metab. 2006, 91: 2843-2850. 10.1210/jc.2005-2611.CrossRefPubMed Perheentupa J: Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy. J Clin Endocrinol Metab. 2006, 91: 2843-2850. 10.1210/jc.2005-2611.CrossRefPubMed
3.
go back to reference Oftedal BE, Wolff AS, Bratland E, Kampe O, Perheentupa J, Myhre AG, Meager A, Purushothaman R, Ten S, Husebye ES: Radioimmunoassay for autoantibodies against interferon omega; its use in the diagnosis of autoimmune polyendocrine syndrome type I. Clin Immunol. 2008, 129: 163-169. 10.1016/j.clim.2008.07.002.CrossRefPubMed Oftedal BE, Wolff AS, Bratland E, Kampe O, Perheentupa J, Myhre AG, Meager A, Purushothaman R, Ten S, Husebye ES: Radioimmunoassay for autoantibodies against interferon omega; its use in the diagnosis of autoimmune polyendocrine syndrome type I. Clin Immunol. 2008, 129: 163-169. 10.1016/j.clim.2008.07.002.CrossRefPubMed
4.
go back to reference Padeh S, Theodor R, Jonas A, Passwell JH: Severe malabsorption in autoimmune polyendocrinopathy-candidosis-ectodermal dystrophy syndrome successfully treated with immunosuppression. Arch Dis Child. 1997, 76: 532-534. 10.1136/adc.76.6.532.CrossRefPubMedPubMedCentral Padeh S, Theodor R, Jonas A, Passwell JH: Severe malabsorption in autoimmune polyendocrinopathy-candidosis-ectodermal dystrophy syndrome successfully treated with immunosuppression. Arch Dis Child. 1997, 76: 532-534. 10.1136/adc.76.6.532.CrossRefPubMedPubMedCentral
5.
go back to reference Ward L, Paquette J, Seidman E, Huot C, Alvarez F, Crock P, Delvin E, Kampe O, Deal C: Severe autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy in an adolescent girl with a novel AIRE mutation: response to immunosuppressive therapy. J Clin Endocrinol Metab. 1999, 84: 844-852. 10.1210/jc.84.3.844.PubMed Ward L, Paquette J, Seidman E, Huot C, Alvarez F, Crock P, Delvin E, Kampe O, Deal C: Severe autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy in an adolescent girl with a novel AIRE mutation: response to immunosuppressive therapy. J Clin Endocrinol Metab. 1999, 84: 844-852. 10.1210/jc.84.3.844.PubMed
6.
go back to reference Perheentupa J: APS-I/APECED: the clinical disease and therapy. Endocrinol Metab Clin North Am. 2002, 31: 295-320. 10.1016/S0889-8529(01)00013-5. viCrossRefPubMed Perheentupa J: APS-I/APECED: the clinical disease and therapy. Endocrinol Metab Clin North Am. 2002, 31: 295-320. 10.1016/S0889-8529(01)00013-5. viCrossRefPubMed
7.
go back to reference Ulinski T, Perrin L, Morris M, Houang M, Cabrol S, Grapin C, Chabbert-Buffet N, Bensman A, Deschenes G, Giurgea I: Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome with renal failure: impact of posttransplant immunosuppression on disease activity. J Clin Endocrinol Metab. 2006, 91: 192-195. 10.1210/jc.2005-1538.CrossRefPubMed Ulinski T, Perrin L, Morris M, Houang M, Cabrol S, Grapin C, Chabbert-Buffet N, Bensman A, Deschenes G, Giurgea I: Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome with renal failure: impact of posttransplant immunosuppression on disease activity. J Clin Endocrinol Metab. 2006, 91: 192-195. 10.1210/jc.2005-1538.CrossRefPubMed
8.
go back to reference Bakrac M, Jurisic V, Kostic T, Popovic V, Pekic S, Kraguljac N, Colovic M: Pure red cell aplasia associated with type I autoimmune polyglandular syndrome-successful response to treatment with mycophenolate mofetil: case report and review of literature. J Clin Pathol. 2007, 60: 717-720. 10.1136/jcp.2006.042671.CrossRefPubMedPubMedCentral Bakrac M, Jurisic V, Kostic T, Popovic V, Pekic S, Kraguljac N, Colovic M: Pure red cell aplasia associated with type I autoimmune polyglandular syndrome-successful response to treatment with mycophenolate mofetil: case report and review of literature. J Clin Pathol. 2007, 60: 717-720. 10.1136/jcp.2006.042671.CrossRefPubMedPubMedCentral
9.
go back to reference Rautemaa R, Hietanen J, Niissalo S, Pirinen S, Perheentupa J: Oral and oesophageal squamous cell carcinoma–a complication or component of autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED, APS-I). Oral Oncol. 2007, 43: 607-613. 10.1016/j.oraloncology.2006.07.005.CrossRefPubMed Rautemaa R, Hietanen J, Niissalo S, Pirinen S, Perheentupa J: Oral and oesophageal squamous cell carcinoma–a complication or component of autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED, APS-I). Oral Oncol. 2007, 43: 607-613. 10.1016/j.oraloncology.2006.07.005.CrossRefPubMed
10.
go back to reference Betterle C, Greggio NA, Volpato M: Clinical review 93: autoimmune polyglandular syndrome type 1. J Clin Endocrinol Metab. 1998, 83: 1049-1055. 10.1210/jc.83.4.1049.CrossRefPubMed Betterle C, Greggio NA, Volpato M: Clinical review 93: autoimmune polyglandular syndrome type 1. J Clin Endocrinol Metab. 1998, 83: 1049-1055. 10.1210/jc.83.4.1049.CrossRefPubMed
Metadata
Title
A child with autoimmune polyendocrinopathy candidiasis and ectodermal dysplasia treated with immunosuppression: a case report
Authors
Clodagh S O’Gorman
Rayzel Shulman
Irene Lara-Corrales
Elena Pope
Margaret Marcon
Hartmut Grasemann
Rayfel Schneider
Julia Upton
Etienne B Sochett
Dror Koltin
Eyal Cohen
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2013
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/1752-1947-7-44

Other articles of this Issue 1/2013

Journal of Medical Case Reports 1/2013 Go to the issue