Clinical analysis of hyperimmunoglobulin E syndrome in children with STAT3 and DOCK8 mutations in different genotypes.

BACKGROUND

Due to the nonspecific clinical manifestations of hyperimmunoglobulin E syndrome (HIES), missed or delayed diagnoses may occur, which can affect treatment efficacy and patient prognosis. This article aims to enhance early recognition and diagnosis of HIES among clinicians.

METHODS

We retrospectively analyzed clinical data from seven children with HIES caused by transcription-3 (STAT3) mutations treated at the Children's Hospital of Nanjing Medical University between August 2014 and March 2021. Additionally, we reviewed relevant literature: using "hyperimmunoglobulin E syndrome" and "DOCK8 gene mutation" as search terms, 18 cases of HIES with dedicator of cytokinesis 8 (DOCK8) mutations in China were retrieved from Wanfang Data. We analyzed the clinical characteristics of these two genetic subtypes and their correlation with genetic variations.

RESULTS

The STAT3 mutation group included five males and two females, with an onset age ranging from two days to eight months. All seven cases presented with eczema and recurrent pulmonary infections; one case had liver abscesses, three had otitis media, one had cervical lymph node infection, one had cervical lymphangioma with infection, and one had infectious arthritis. Six cases showed elevated serum total immunoglobulin E (IgE) levels and peripheral blood eosinophil (EOS) counts. All children in this group had activating STAT3 mutations: one case with confirmed gene sequencing but unknown mutation site, five with de novo mutations, and one with no parental genetic testing. The DOCK8 mutation group included four males and 14 females, with an onset age ranging from half-month-old to three years. All 18 cases had eczema and recurrent pulmonary infections; six had food allergies, one had asthma, and one had autoimmune hemolysis. Serum total IgE levels were elevated in all 18 cases, and peripheral blood EOS counts were elevated in 17 cases. All children in this group had homozygous or compound heterozygous DOCK8 mutations, including large-fragment deletions, missense mutations, or frameshift mutations.

CONCLUSIONS

Early in the course of HIES, clinical manifestations are often nonspecific. HIES should be considered in patients with recurrent eczema, skin abscesses, and pulmonary infections-especially when combined with facial or skeletal abnormalities. Early recognition facilitates timely treatment, and genetic testing can aid in early diagnosis.