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Wiskott–Aldrich syndrome presenting with a clinical picture mimicking juvenile myelomonocytic leukaemia
Author(s) -
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
Publication year - 2013
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.24359
Subject(s) - juvenile myelomonocytic leukemia , monocytosis , medicine , wiskott–aldrich syndrome , leukocytosis , myeloid , bone marrow , ptpn11 , pathology , immunology , gastroenterology , gene , biology , kras , stem cell , genetics , cancer , haematopoiesis , colorectal cancer
Background Wiskott–Aldrich syndrome (WAS) is a rare X‐linked immunodeficiency caused by defects of the WAS protein ( WASP ) gene. Patients with WAS typically demonstrate micro‐thrombocytopenia. Procedures 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). Results 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 WASP 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. Conclusions 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.