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Blau Syndrome

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Auto-Inflammatory Syndromes
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Abstract

Blau syndrome is a monogenic inflammatory disease that classically involves the triad of arthritis, uveitis, and dermatitis. This syndrome is the familial form of early-onset sarcoidosis, and the two entities have some shared mutations in the NOD2 gene. Blau syndrome was first described in 1985 and is characterized predominantly by granulomas in the affected areas. Management remains a challenge, as Blau syndrome is rare and evidence is lacking. Here, we describe in greater detail the clinical features, pathophysiology, diagnosis, management, and prognosis of Blau syndrome.

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References

  1. Blau EB. Familial granulomatous arthritis, iritis, and rash. J Pediatr. 1985;107(5):689–93.

    Article  CAS  Google Scholar 

  2. Jabs DA, et al. Familial granulomatous synovitis, uveitis, and cranial neuropathies. Am J Med. May 1985;78(5):801–4.

    Article  CAS  Google Scholar 

  3. Miceli-Richard C, et al. CARD15 mutations in Blau syndrome. Nat Genet. 2001;29(1):15. https://doi.org/10.1038/ng720.

    Article  CAS  Google Scholar 

  4. Wouters CH, et al. Blau syndrome, the prototypic auto-inflammatory granulomatous disease. Pediatr Rheumatol Online J. 2014;12:33. https://doi.org/10.1186/1546-0096-12-33.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Rosé CD, et al. Pediatric granulomatous arthritis: an international registry. Arthritis Rheum. 2006;54(10):3337–44. https://doi.org/10.1002/art.22122.

    Article  PubMed  Google Scholar 

  6. Rosé CD, et al. Blau syndrome: cross-sectional data from a multicentre study of clinical, radiological and functional outcomes. Rheumatology (Oxford, England). 2015;54(6):1008–16. https://doi.org/10.1093/rheumatology/keu437.

    Article  CAS  Google Scholar 

  7. Tromp G, et al. Genetic linkage of familial granulomatous inflammatory arthritis, skin rash, and uveitis to chromosome 16. Am J Hum Genet. 1996;59(5):1097–107.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Ogura Y, et al. Nod2, a Nod1/Apaf-1 family member that is restricted to monocytes and activates NF-kappaB. J Biol Chem. 2001;276(7):4812–8. https://doi.org/10.1074/jbc.M008072200.

    Article  CAS  PubMed  Google Scholar 

  9. Lecat A, Piette J, Legrand-Poels S. The protein Nod2: an innate receptor more complex than previously assumed. Biochem Pharmacol. 2010;80(12):2021–31. https://doi.org/10.1016/j.bcp.2010.07.016.

    Article  CAS  PubMed  Google Scholar 

  10. Caso F, et al. Caveats and truths in genetic, clinical, autoimmune and autoinflammatory issues in Blau syndrome and early onset sarcoidosis. Autoimmun Rev. 2014;13(12):1220–9. https://doi.org/10.1016/j.autrev.2014.08.010.

    Article  PubMed  Google Scholar 

  11. Rose CD, Martin TM, Wouters CH. Blau syndrome revisited. Curr Opin Rheumatol. 2011;23(5):411–8. https://doi.org/10.1097/BOR.0b013e328349c430.

    Article  CAS  PubMed  Google Scholar 

  12. Milman N, et al. A novel mutation in the NOD2 gene associated with Blau syndrome: a Norwegian family with four affected members. Scand J Rheumatol. 2009;38(3):190–7. https://doi.org/10.1080/03009740802464194.

    Article  CAS  PubMed  Google Scholar 

  13. Okada S, et al. Cardiac infiltration in early-onset sarcoidosis associated with a novel heterozygous mutation, G481D, in CARD15. Rheumatology (Oxford, England). 2009;48(6):706–7. https://doi.org/10.1093/rheumatology/kep061.

    Article  CAS  Google Scholar 

  14. Sakai H, et al. A case of early-onset sarcoidosis with a six-base deletion in the NOD2 gene. Rheumatology (Oxford, England). 2010;49(1):194–6. https://doi.org/10.1093/rheumatology/kep315.

    Article  CAS  Google Scholar 

  15. van Duist MM, et al. A new CARD15 mutation in Blau syndrome. Eur J Hum Genet: EJHG. 2005;13(6):742–7. https://doi.org/10.1038/sj.ejhg.5201404.

    Article  CAS  PubMed  Google Scholar 

  16. Villanueva-Mendoza C, et al. Familial case of Blau syndrome associated with a CARD15/NOD2 mutation. Ophthalmic Genet. 2010;31(3):155–8. https://doi.org/10.3109/13816810.2010.492818.

    Article  CAS  PubMed  Google Scholar 

  17. Kanazawa N, et al. Early-onset sarcoidosis and CARD15 mutations with constitutive nuclear factor-kappaB activation: common genetic etiology with Blau syndrome. Blood. 2005;105(3):1195–7. https://doi.org/10.1182/blood-2004-07-2972.

    Article  CAS  PubMed  Google Scholar 

  18. Wang X, et al. CARD15 mutations in familial granulomatosis syndromes: a study of the original Blau syndrome kindred and other families with large-vessel arteritis and cranial neuropathy. Arthritis Rheum. 2002;46(11):3041–5. https://doi.org/10.1002/art.10618.

    Article  CAS  PubMed  Google Scholar 

  19. Barnich N, et al. Membrane recruitment of NOD2 in intestinal epithelial cells is essential for nuclear factor-{kappa}B activation in Muramyl dipeptide recognition. J Cell Biol. 2005;170(1):21–6. https://doi.org/10.1083/jcb.200502153.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Tattoli I, et al. The nodosome: Nod1 and Nod2 control bacterial infections and inflammation. Semin Immunopathol. 2007;29(3):289–301. https://doi.org/10.1007/s00281-007-0083-2.

    Article  CAS  PubMed  Google Scholar 

  21. Saulsbury FT, et al. Incomplete penetrance of the NOD2 E383K substitution among members of a pediatric granulomatous arthritis pedigree. Arthritis Rheum. 2009;60(6):1804–6. https://doi.org/10.1002/art.24532.

    Article  CAS  PubMed  Google Scholar 

  22. Janssen CEI, et al. Morphologic and immunohistochemical characterization of granulomas in the nucleotide oligomerization domain 2-related disorders Blau syndrome and Crohn disease. J Allergy Clin Immunol. 2012;129(4):1076–84. https://doi.org/10.1016/j.jaci.2012.02.004.

    Article  CAS  PubMed  Google Scholar 

  23. Vitale A, et al. Biological treatments: new weapons in the management of monogenic autoinflammatory disorders. Mediat Inflamm. 2013;2013:939847. https://doi.org/10.1155/2013/939847.

    Article  CAS  Google Scholar 

  24. Sfriso P, et al. Blau syndrome, clinical and genetic aspects. Autoimmun Rev. 2012;12(1):44–51. https://doi.org/10.1016/j.autrev.2012.07.028.

    Article  CAS  PubMed  Google Scholar 

  25. Yasui K, et al. Thalidomide dramatically improves the symptoms of early-onset sarcoidosis/Blau syndrome: its possible action and mechanism. Arthritis Rheum. 2010;62(1):250–7. https://doi.org/10.1002/art.25035.

    Article  CAS  PubMed  Google Scholar 

  26. Chauhan K, Michet C. A case of Blau syndrome. Case Rep Rheumatol. 2014;2014:216056. https://doi.org/10.1155/2014/216056.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Milman N, et al. Favourable effect of TNF-alpha inhibitor (infliximab) on Blau syndrome in monozygotic twins with a de novo CARD15 mutation. APMIS. 2006;114(12):912–9. https://doi.org/10.1111/j.1600-0463.2006.apm_522.x.

    Article  PubMed  Google Scholar 

  28. Otsubo Y, et al. A long-term follow-up of Japanese mother and her daughter with Blau syndrome: effective treatment of anti-TNF inhibitors and useful diagnostic tool of joint ultrasound examination. Mod Rheumatol. 2017;27(1):169–73. https://doi.org/10.3109/14397595.2014.964388.

    Article  PubMed  Google Scholar 

  29. Aróstegui JI, et al. NOD2 gene-associated pediatric granulomatous arthritis: clinical diversity, novel and recurrent mutations, and evidence of clinical improvement with interleukin-1 blockade in a Spanish cohort. Arthritis Rheum. 2007;56(11):3805–13. https://doi.org/10.1002/art.22966.

    Article  CAS  PubMed  Google Scholar 

  30. Simonini G, et al. Clinical and transcriptional response to the long-acting Interleukin-1 blocker canakinumab in Blau syndrome-related uveitis. Arthritis Rheum. February 2013;65(2):513–8. https://doi.org/10.1002/art.37776.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Martin TM, et al. The NOD2 defect in Blau syndrome does not result in excess interleukin-1 activity. Arthritis Rheum. 2009;60(2):611–8. https://doi.org/10.1002/art.24222.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Correspondence to Karen B. Onel .

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Trachtman, R., Onel, K.B. (2019). Blau Syndrome. In: Efthimiou, P. (eds) Auto-Inflammatory Syndromes. Springer, Cham. https://doi.org/10.1007/978-3-319-96929-9_5

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  • DOI: https://doi.org/10.1007/978-3-319-96929-9_5

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