Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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A Korean familial case of hereditary complement 7 deficiency

선천성 보체 7번 결핍을 가진 한국인 한 가족

  • Kim, Moon Kyu (Department of Immunology, School of Medicine, Kyungpook National University Hospital) ;
  • Lee, Kyung Yul (Department of Physical Education, Kyungnam University) ;
  • Lee, Jun Hwa (Department of Pediatrics, Masan Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 김문규 (경북대학교 의과대학 면역학교실) ;
  • 이경열 (경남대학교 체육교육학과) ;
  • 이준화 (성균관대학교 의과대학 마산삼성병원 소아청소년과)
  • Received : 2009.02.05
  • Accepted : 2009.05.22
  • Published : 2009.06.15
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Abstract

Meningococcal infections can be associated with abnormalities of the complement system, which contains 5 terminal complement proteins. Furthermore, deficiencies in 1 of these 5, complement component 7 (C7), leads to the loss of complement lytic function, and affected patients show increased susceptibility to recurrent meningococcal meningitis and systemic Neisseria gonorrhoeae infection. In September 2003, an 11-year-old female patient presented at our outpatient department with high fever, lower leg pain, headache, and petechiaes. She rapidly progressed to coma but later achieved full recovery due to prompt treatment. Her final diagnosis was meningococcal sepsis and arthritis. Her elder brother also had a similar bacterial meningoencephalitis history, which encouraged us to perform analyses for complement component and gene mutations. Resultantly, both the brother and sister were found to have the same mutation in the C7 gene. Subsequently, vaccinations of the meningococcal vaccine meningococcal vaccine ($Menomune^{(R)}$) were administered. However, in September 2006, the brother expired due to acute micrococcus meningoencephalitis. At present, the 16-year-old female patient is healthy. Here, we report a Korean family with a hereditary C7 deficiency with susceptibility to meningococcal infections due to C7 gene mutation.

수막구균(Meningococcus) 질환은 보체계의 이상과 관련이 있을 수 있다. 보체 7번은 5개의 말단 보체 단백질(terminal complement protein) 중 하나로 이것이 결핍되면 보체의 세포를 용해하는 작용을 잃게 되어 반복적인 감염, 특히 수막구균 감염에 대한 감수성이 증가한다. 2003년 9월 고열, 하지 동통, 두통과 점상 출혈로 외래에 내원한 11세 된 여자 환자가 입원 후 급격히 혼수 상태로 빠졌으나 즉각적인 치료로 결국 완전히 회복되었다. 환자의 최종 진단은 수막구균성 패혈증과 관절염이었다. 환자의 오빠도 비슷한 세균성 뇌수막염 가족력이 있어 저자들은 보체계 검사와 유전자 돌연변이(gene mutation)에 대해 분석하였고, 환자와 환자의 오빠는 보체 7번 유전자의 exon 4에 G394C에 돌연변이가 있는 선천성 보체 7번 결핍 환자였고, 아빠는 보인자로 밝혀졌다. 저자들은 예방적으로 4가 수막구균 백신(tetravalent polysaccharide meningococcal vaccine, $Menomune^{(R)}$ A/C/Y/W-135, Aventis Pasteur, Canada)을 3년마다 접종하기로 하였고 2004년 10월에 처음으로 접종하였다. 그러나 2006년 9월 오빠는 급성 세균성 뇌수막염(meningoencephalitis)으로 사망하였다. 이에 저자들은 2년마다 예방적 접종을 하기로 하였고, 환자는 2008년 9월에 3번째로 접종하였으며 16세 된 환자는 현재까지 건강한 상태이다. 저자들은 수막구균 감염과 보체 7번 유전자 네번째 intron의 3' 말단 splice acceptor 위치에 G to T 돌연변이(g.IVS4-1G> T)가 있는 선천성 보체 7번 결핍을 가진 한국인 한 가족을 보고하는 바이다.

Keywords

References

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