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- Hyperimmunoglobulinemia E
- Job syndrome
- intracranial aneurysm
- mycotic aneurysm
- infectious diseases
- molecular immunogene
- subarachnoid haemorrhage
Hyperimmunoglobulinaemia E (HIES) syndrome is a rare immunodeficiency disease inherited as a single locus autosomal dominant trait with variable expression1 presenting with multisystem infections.2 The diagnosis is based on a scoring system assessing multiple features such as chronic eczema, recurrent pyogenic skin and lung infections, significantly increased serum levels of immunoglobulin E (>2000 IU), peripheral eosinophilia, characteristic faces, joint hyperextensibility, and pathological long bone fractures.1 Treatment includes medical and surgical management of the infections and, in severe cases, intravenous administration of immunoglobulin or recombinant interferon gamma. Central nervous system (CNS) abnormalities such as lacunar infarctions, Chiari type 1 malformations, cerebritis and parenchymal and subarachnoid haemorrhage (SAH) are common in this syndrome.2
Despite the known CNS involvement,2 this syndrome has not been previously described in the neurosurgical literature. We present two cases with known HIES with aneurysmal SAH and discuss possible causes of aneurysm formation.
Both patients with confirmed diagnosis of HIES were followed up at the Warren Grant Magnuson Clinical Center under protocol 93-I-0119 with informed consent.
A 29-year-old woman was admitted presenting with persistent headaches over a 2-week period, accompanied by transient right-sided weakness and loss of consciousness. In the interim, she had multiple severe skin infections, cavitary pulmonary aspergillosis and facial cellulitis. Her Hunt and Hess grade on admission was 4 (World Federation of Neurological Surgeons grade 4+; Glasgow coma score 8), accompanied by mild nuchal rigidity, right sensory deficits and right-sided hyperreflexia (3++/4) without Babinski sign. …
Funding This study was funded by the National Institutes of Health and the Swiss National Science Foundation.
Competing interests None.
Ethics approval This study was conducted with the approval of both patients who were followed up at the Warren Grant Magnuson Clinical Center under protocol 93-I-0119.
Provenance and peer review Not commissioned; externally peer reviewed.