Vasculitis associated with adenosine deaminase 2 deficiency: at the crossroads between Behçet's disease and autoinflammation. A viewpoint

Reumatismo. 2023 Sep 18;75(3). doi: 10.4081/reumatismo.2023.1578.

Abstract

Adenosine deaminase 2 deficiency (DADA2) is a rare monogenic vasculopathy caused by loss-of-function homozygous or compound heterozygous mutations in ADA2, formerly CECR1 (cat eye syndrome chromosome region 1) gene. The DADA2 phenotype is widely heterogeneous, and patients may present with fever, weight loss, livedo reticularis/racemosa, digital ischemia, cutaneous ulceration, peripheral neuropathy, abdominal pain, bowel perforation, and portal or nephrogenic hypertension. More specific manifestations include early-onset ischemic or hemorrhagic stroke, mild immunodeficiency and hypogammaglobinemia, cytopenia, and vision disturbances. Herein, we present the case of a young male with vasculitis associated with DADA2. The presence of HLA-B51 and the clinical features of this patient raised the question of similarities between ADA2 deficiency, Behçet's disease, and NOD2-associated diseases. Treatment of this rare monogenic disease is challenging and based on small case series. The long-term experience of this patient proved the difficulties of prednisone tapering and the lack of satisfactory therapeutic strategies.

Publication types

  • Case Reports

MeSH terms

  • Adenosine Deaminase / genetics
  • Behcet Syndrome* / complications
  • Behcet Syndrome* / diagnosis
  • Behcet Syndrome* / drug therapy
  • Humans
  • Intercellular Signaling Peptides and Proteins / genetics
  • Male
  • Vasculitis* / etiology

Substances

  • Adenosine Deaminase
  • Intercellular Signaling Peptides and Proteins

Supplementary concepts

  • deficiency of adenosine deaminase 2
  • Severe combined immunodeficiency due to adenosine deaminase deficiency