A homozygous CARD9 mutation in a Brazilian patient with deep dermatophytosis

J Clin Immunol. 2015 Jul;35(5):486-90. doi: 10.1007/s10875-015-0170-4. Epub 2015 Jun 5.

Abstract

Deep dermatophytosis has been described in HIV and immunosuppressed patients. Recently, CARD9 (caspase recruitment domain-containing protein 9) deficiency has been reported in individuals with deep dermatophytosis previously classified as "immunocompetent". We report a 24-year-old Brazilian male patient with deep dermatophytosis born to an apparently non-consanguineous family. The symptoms started with oral candidiasis when he was 3 years old, persistent although treated. At 11 years old, well delimited, desquamative and pruriginous skin lesions appeared in the mandibular area; ketoconazole and itraconazole were introduced and maintained for 5 years. At 12 years of age, the lesions, which initially affected the face, started to spread to thoracic and back of the body (15 cm of diameter) and became ulcerative, secretive and painful. Terbinafine was introduced without any improvement. Trichophyton mentagrophytes was isolated from the skin lesions. A novel homozygous mutation in CARD9 (R101L) was identified in the patient, resulting in impaired neutrophil fungal killing. Both parents, one brother (with persistent superficial but not deep dermatophytosis) and one sister were heterozygous for this mutation, while another brother was found to be homozygous for the CARD9 wild-type allele. This is the first report of CARD9 deficiency in Latin America.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Brazil
  • CARD Signaling Adaptor Proteins / genetics*
  • CARD Signaling Adaptor Proteins / isolation & purification
  • Candidiasis, Oral / diagnosis*
  • Candidiasis, Oral / genetics
  • Child
  • Child, Preschool
  • Cytotoxicity, Immunologic / genetics
  • Female
  • Genetic Predisposition to Disease
  • Homozygote
  • Humans
  • Male
  • Neutrophils / microbiology
  • Neutrophils / physiology*
  • Pedigree
  • Sequence Deletion / genetics
  • Skin / microbiology
  • Skin / pathology*
  • Tinea / diagnosis*
  • Tinea / genetics
  • Young Adult

Substances

  • CARD Signaling Adaptor Proteins
  • CARD9 protein, human

Supplementary concepts

  • Trichophyton infection