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Case Reports Journal Article Ppublish 3 citations

PubMed: 38801808 DOI: 10.1016/j.clineuro.2024.108351

Central nervous system vasculitis in VEXAS syndrome: A rare involvemen.

Clin Neurol Neurosurg 242:108351

Authors: V Langlois, A Curie, A Demas, P Etancelin, G Sauvètre, A Leclancher, A Mekinian

Affiliations

  • Service de médecine interne et maladies infectieuses, Groupe Hospitalier du Havre, France.
  • Service de médecine interne et maladies infectieuses, Groupe Hospitalier du Havre, France; Service de médecine interne, Centre Hospitalier Eure Seine, Evreux, France.
  • Service de neurologie, Groupe hospitalier du Havre, France.
  • Laboratoire de génétique oncologique, Centre de lutte contre le cancer Henri Becquerel, Rouen, France.
  • Service de médecine interne, CHU de Rouen, France.
  • Service de médecine interne, Hôpital Saint Antoine, Paris, France.

Abstract

INTRODUCTION

VEXAS (Vacuoles, E1 Enzyme, X-linked, autoinflammatory, Somatic) syndrome is a recently described severe adult-onset autoinflammatory disorder mediated by X-linked gene UBA1 somatic mutations, responsible of recurrent fever, skin involvement, chondritis, macrocytic anemia and inflammatory syndrome. Neurological manifestations are rarely described, and predominantly involve peripheral nervous system (PNS) impairment.

RESULTS

We report the first central nervous system (CNS) vasculitis in VEXAS syndrome, characterized by headache, cognitive dysfunction and focal signs (cerebellar ataxia). Magnetic resonance imaging (MRI) revealed multifocal white-matter lesions corresponding to recent ischemic strokes, combined with cortical hemorrhagic lesions and gadolinium enhancement of the distal wall vessels. Treatment with methylprednisone, ruxolitinib and tocilizumab led to clinical improvement and a decrease of the inflammatory syndrome. The patient died few months after due to infectious complications.

CONCLUSION

CNS vasculitis, occurring as a manifestation of the systemic auto-inflammatory state of VEXAS syndrome, might be a rare but severe complication. We suggest that it be added to the list of inflammatory vasculopathies. More prospective studies are needed to optimize the treatment.

MeSH

Neurosurgery, Neurology, Vasculitis, Central Nervous System, Genes, X-Linked

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