Concomitant diagnosis of immune deficiency and Pseudomonas sepsis in a 19 month old with ecthyma gangrenosum by host whole-genome sequencing

Cold Spring Harb Mol Case Stud. 2018 Dec 17;4(6):a003244. doi: 10.1101/mcs.a003244. Print 2018 Dec.

Abstract

X-linked agammaglobulinemia (XLA, OMIM#300300) is a rare monogenic primary immunodeficiency caused by mutations in the Bruton tyrosine kinase (BTK) gene. XLA is characterized by insufficient immunoglobulin levels and susceptibility to life-threatening bacterial infections. We report on a patient that presented with ecthyma gangrenosum and septicemia. Rapid trio whole-genome sequencing (rWGS) revealed an apparently de novo hemizygous pathogenic variant (c.726dupT; p.Ile243TyrfsTer15) in the BTK gene. Metagenomic analysis of rWGS sequences that did not align to the human genome revealed 770 aligned to the Pseudomonas aeruginosa PAO1 genome. The patient was diagnosed with XLA and pseudomonal sepsis.

Keywords: congenital neutropenia; immune dysregulation; sepsis.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Agammaglobulinaemia Tyrosine Kinase / genetics*
  • Agammaglobulinaemia Tyrosine Kinase / metabolism
  • Agammaglobulinemia / diagnosis
  • Agammaglobulinemia / genetics*
  • Bacteremia
  • Ecthyma / diagnosis
  • Ecthyma / genetics*
  • Gangrene / microbiology
  • Genetic Diseases, X-Linked / diagnosis
  • Genetic Diseases, X-Linked / genetics*
  • Humans
  • Immunologic Deficiency Syndromes
  • Infant
  • Male
  • Pseudomonas Infections / genetics
  • Pseudomonas aeruginosa / genetics
  • Pseudomonas aeruginosa / pathogenicity
  • Sepsis / genetics
  • Sepsis / metabolism
  • Skin / microbiology
  • Whole Genome Sequencing / methods

Substances

  • Agammaglobulinaemia Tyrosine Kinase

Supplementary concepts

  • Bruton type agammaglobulinemia