[HLA-DRB1 typing in Caucasians patients with neuromyelitis optica]. / HLA-DRB1 en pacientes caucasicos con neuromielitis optica.

INTRODUCTION: The existence of antibodies to aquaporin-4 (AQP-4-ab) has identified neuromyelitis optica (NMO) and multiple sclerosis (MS) as different diseases. Although HLA-DRB1 alleles contribute to MS risk, recent studies suggest that HLA back-ground differs between patients with NMO or MS in non-Caucasians populations. Our study was aimed to analyze HLA-DRB1 distribution in Caucasians NMO patients. SUBJECTS AND METHODS: We recruited a cohort of 22 NMO patients (73% were AQP-4-ab positive), 228 MS patients and 225 healthy controls from Spain and we genotyped the HLA-DRB1 locus. Then, we performed a pool analysis using reported data from 45 NMO patients (53% were AQP-4-ab positive), 156 MS patients and 310 healthy controls from Caucasian French population. RESULTS: In the Spanish cohort, NMO was associated with increased frequency of DRB1*10 allele compared with MS (odds ratio, OR = 15.1; 95% confidence interval, 95% CI = 3.26-69.84; p = 0.012). In the pooled analysis, by comparison with healthy controls, NMO was associated with increased frequency of DRB1*03 allele (OR = 2.27; 95% CI = 1.44-3.58; p < 0.0008) which was related to AQP-4-ab seropositivity (OR = 2.74; 95% CI = 1.58-4.77; p < 0.0008). By contrast, MS was associated with increased frequency of DRB1*15 allele (OR = 2.09; 95% CI = 1.62-2.68; p < 0.0008) and decreased frequency of DRB1*07 allele (OR = 0.58; 95% CI = 0.44-0.78; p < 0.0008). CONCLUSIONS: Caucasian patients with NMO and MS have a different HLA-DRB1 allelic distribution. DRB1*03 allele seems to contribute to NMO seropositivity. Multicenter collaborative efforts are needed to adequately address the genetic contribution to NMO susceptibility.

[Early onset Neurobehçet's disease]. / Neurobehçet de presentación precoz.

INTRODUCTION: Behçet's disease is difficult to diagnose in infancy due to the absence of early clinicopathological pathognomonic symptoms. There have been reports of patients in whom the onset of the disease occurred during the first months of their lives. CASE REPORT: We describe here the case of a 12-year-old female from Pakistan whose first symptoms appeared at the age of 6 months in the form of fever and skin lesions. The first neurological symptoms appeared at the age of 5 years in the form of ophthalmoplegia, followed by ataxia and dysmetry. Magnetic resonance imaging of the head was a valuable aid in the study of the vascular alterations. She also presented abdominal pains, arthromyalgia, ulcers in the mouth and severely delayed weight gain. Yet, we were finally guided towards a diagnosis by the appearance of ulcers on the genitals, which do not usually occur until puberty, as well as the findings from the skin biopsy study. The serological study revealed the presence of antigen B08. Establishing therapy with methylprednisolone and later with azathioprine brought about the practically complete remission of the clinical picture. CONCLUSIONS: Behçet's disease, which has been infrequent in our country up till now, is a condition to be taken into account, especially in young female patients from countries with a high incidence rate of oral and genital ulcers, accompanied by neurological symptoms. Knowledge of this syndrome and performing appropriate complementary studies are essential to be able to reach an early diagnosis and for establishing suitable treatment.

Neurobehçet de presentación precoz / Early onset Neurobehçet’s disease

Introducción. La enfermedad de Behçet es de difícil diagnóstico en la infancia debido a la ausencia de manifestaciones clinicopatológicas patognomónicas precoces. Se han descrito pacientes de inicio desde los primeros meses de vida. Caso clínico. Niña de 12años de origen paquistaní, cuyas primeras manifestaciones aparecieron a los 6 meses en forma de fiebre y lesiones cutáneas. A los 5años surgió la primera manifestación neurológica en forma de oftalmoplejía, posteriormente ataxia y dismetría. La resonancia magnética craneal resultó útil en el estudio de las alteraciones vasculares. También presentó dolores abdominales, artromialgias, úlceras orales y grave retraso ponderal. Pero fueron las úlceras genitales, que no suelen presentarse hasta la pubertad, así como el resultado de la biopsia cutánea, lo que orientó hacia el diagnóstico. El estudio serológico mostró la presencia del antígeno B08. La instauración de tratamiento con metilprednisolona y posteriormente azatioprina supusola remisión prácticamente completa del cuadro clínico. Conclusiones. La enfermedad de Behçet, infrecuente hasta ahora en nuestro país, es una entidad a tener en cuenta, especialmente en niñas procedentes de países con alta incidencia de úlceras orales y genitales, acompañadas de manifestaciones neurológicas. El conocimiento de dicho síndrome y la realización de estudios complementarios adecuados es imprescindible para un diagnóstico precoz y la instauración de un tratamiento adecuado (AU)

Introduction. Behçet's disease is difficult to diagnose in infancy due to the absence of early clinic pathological pathognomonic symptoms. There have been reports of patients in whom the onset of the disease occurred during the first months of their lives. Case report. We describe here the case of a 12-year-old female from Pakistan whose first symptoms appeared at the age of 6 months in the form of fever and skin lesions. The first neurological symptoms appeared at the age of 5 years in the form of ophthalmoplegia, followed by ataxia and dysmetry. Magnetic resonance imaging of the head was a valuable aid in the study of the vascular alterations. She also presented abdominal pains, arthromyalgia, ulcers in the mouth and severely delayed weight gain. Yet, we were finally guided towards a diagnosis by the appearance of ulcers on the genitals, which do not usually occur until puberty, as well as the findings from the skin biopsy study. The serological study revealed the presence of antigen B08.Establishing therapy with methylprednisolone and later with azathioprine brought about the practically complete remission of the clinical picture. Conclusions. Behçet's disease, which has been infrequent in our country up till now, is a condition to betaken into account, especially in young female patients from countries with a high incidence rate of oral and genital ulcers, accompanied by neurological symptoms. Knowledge of this syndrome and performing appropriate complementary studies are essential to be able to reach an early diagnosis and for establishing suitable treatment (AU)

Raised serum alkaline phosphatase activity in one family.

Eleven members of the same family were studied after an incidental detection of raised serum alkaline phosphatase activity in one of them without any apparent underlying cause. Three other members were found to have the same abnormality; none of them had an associated disease. In the four cases with elevated serum alkaline phosphatase levels, its activity showed a preponderance of the bone isoenzyme. Studies of the erythrocyte and histocompatibility antigens in nine members of the family, as well as idiograms of karyotypes of four of them, did not show any relation between histocompatibility antigens and the raised levels of serum alkaline phosphatase. Also, no chromosomal abnormality is shown from karyotypes. The data suggest a probable autosomal dominant pattern of inheritance.