Table 2:
Diagnostic Evaluation
Diagnostic Evaluation | ||||
---|---|---|---|---|
Infectious Studies | Patient A | Patient B | Patient C | Patient D |
Adenovirus Blood PCR | Neg | Neg | ||
Blood Bacterial Culture | Neg | Neg | Neg | |
Cytomegalovirus Blood PCR | Neg | Neg | Neg | Neg |
Epstein-Barr Virus Blood PCR | Neg | Neg | Neg | Neg |
Enterovirus Blood PCR | Neg | |||
Hepatitis A Antibody | Neg | Neg | Neg | |
Hepatitis B Surface Antigen | Neg | Neg | Neg | Neg |
Hepatitis C Antibody | Neg | Neg | Neg | Neg |
Hepatitis E Antibody | Neg | Neg | Neg | |
Herpes Simplex Virus Blood PCR | Neg | Neg | Neg | |
Human Herpesvirus 6 Blood PCR | Neg | Neg | Neg | Neg |
Human Immunodeficiency Virus | Neg | Neg | Neg | Neg |
Human T-Lymphotropic Virus | Neg | Neg | ||
Parvovirus B19 Blood PCR | Neg | Neg | Neg | |
Respiratory Virus Panel | Neg | Neg | ||
Urine Bacterial Culture | Neg | |||
Genetic Studies | ||||
Alpha-1 Anti-Trypsin Level | Normal | Normal | Normal | Normal |
Autoimmune | Neg | |||
Bone Marrow Failure Panel1 | Neg | |||
Ceruloplasmin | Normal | Normal | Normal | Normal |
Chromosome Fragility Study | Normal | Insufficient Cells | Normal | Insufficient Cells |
Copper (Quantitative, Liver) | Normal | |||
Dyskeratosis Congenita Panel2 | Neg | |||
Fanconi Mutagen Sensitivity | Neg | Neg | Neg | |
HLH Panel3 | Neg | |||
Myelodysplastic Syndrome Panel4 | Neg | Neg | ||
Paroxysmal Nocturnal | Neg | |||
Primary Immunodeficiency Panel5 | Neg | |||
Telomere Length Measurement | Normal | Normal | Normal | Normal |
Whole Exome Sequencing | Neg | Neg | Mutation: TNFRSF13B, variant c.542C>A | |
XIAP Protein Expression | Normal | |||
Autoimmune Studies | ||||
ANA | Neg | Neg | Pos 1:80 | Neg |
Anti-LKM | Neg | Neg | Neg | Neg |
Anti-Smooth Muscle Antibody | Neg | Neg | Neg | Neg |
c-ANCA | Neg | |||
Liver Cytosol Antibody | Neg | Neg | ||
Lymphocyte Stimulation | Low | |||
p-ANCA | Neg | |||
Panel Reactive Antibody | Normal | |||
Soluble Liver Antigen | Neg | Neg | Neg | |
Toxin Studies | ||||
Serum Acetaminophen Level | Normal | Normal | Normal | |
Urine Drug Screen | Neg | |||
Anatomic Evaluation | ||||
Anatomy on Ultrasound* | Normal | Normal | Normal | Normal |
Anatomy on MRCP* | Normal | Normal | Normal | Normal |
All imaging had abnormalities consistent with acute hepatitis, but no anatomic abnormalities]
Genes Tested in Panels:
ACD, AK2, ANKRD26, ATR, BRCA1, BRCA2, BRIP1, CEBPA, CECR1, CSF3R, CTC1, DDX41, DKC1, ELANE, ERCC4, ETV6, FANCA, FANB, FANCC, FANCD2, FANCE, FANCF, FANCG, FANCI, FANCL, FANCM, G6PC3, GATA1, GATA2, GFI1, GFI1B, HAX1, JAGN1, LIG4, MPL, NBN, NHP2, NOP10, PALB2, PARN, PAX5, RAB27A, RAD51, RAD51C, RMRP, RPL11, RPL15, RPL19, RPL23, RPL26, RPL27, RPL31, RPL35A, RPL36, RPL5, RPS10, RPS15, RPS17, RPS19, RPS24, RPS26, RPS27, RPS27A, RPS28, RPS29, RPS7, RTEL1, RUNX1, SAMD9, SAMD9L, SBDS, SLX4, SRP72, TAZ, TCIRG1, TERC, TERT, THPO, TINF2, TP53, TSR2, UBE2T, USB1, VPS13B, VPS45, WAS, WRAP532
DKC1, NHP2, NOP10, TERC, TERT, TINF2, and WRAP53
AP3B1, BLOC1S6 (PLDN), TNFRSF7 (CD27), ITK, LYST, MAGT1, PRF1, RAB27A, SH2D1A, SLC7A7, STX11, STXBP2, UNCI3D, XIAP (BIRC4), 253 Kb inversion, UNC13D (MUNC13–4)
Chromosome enumeration assay for interphase cells using chromosome 5, 7, 8, and 20q12 DNA probes; myeloid/lymphoid leukemia (MLL) gene at 11q23
ACD, ACP5, ACTB, ADA, ADAM17, ADAR, AICDA, AIRE, AK2, AP3B1, ARPC1B, ATM, BACH2, BCL10, BCL11B, BLM, BLNK, BTK, C1QA, C1QB, C1QC, C1S, C2, C3, CARD11, CARD14, CARD9, CASP10, CASP8, CD19, CD247, CD27, CD3D, CD3E, CD3G, CD40, CD40LG, CD46, CD55, CD59, CD70, CD79A, CD79B, CD81, CD8A, CDCA7, CEBPE, CECR1, CFB, CFD, CFH, CFI, CFP, CFTR, CHD7, CIITA, CLCN7, CLPB, COLEC11, COPA, CORO1A, CR2, CSF2RA, CSF2RB, CSF3R, CTC1, CTLA4, CTPS1, CTSC, CXCR4, CYBA, CYBB, DCLRE1C, DDX58, DGKE, DKC1, DNAJC21, DNMT3B, DOCK2, DOCK8, ELANE, EPG5, ERCC6L2, EXTL3, FADD, FAS, FASLG, FERMT3, FOXN1, FOXP3, G6PC3, G6PD, GATA2, GFI1, GINS1, HAX1, HELLS, HYOU1, ICOS, IFIH1, IFNAR2, IFNGR1, IFNGR2, IGLL1, IKBKB, IKZF1#, IL10, IL10RA, IL10RB, IL12B, IL12RB1, IL17RA, IL17RC, IL1RN, IL21, IL21R, IL2RA, IL2RG, IL36RN, IL7R, IRAK4, IRF2BP2, IRF8, ISG15, ITGB2, ITK, JAGN1, JAK1, JAK3, KRAS, LAMTOR2, LAT, LCK, LIG4, LPIN2, LRBA, LYST, MAGT1, MALT1, MAP3K14, MASP1, MEFV, MKL1, MOGS, MRE11A, MSN, MTHFD1, MVK, MYD88, MYO5A, NBN, NCF1, NCF2, NCF4, NCSTN, NFKB1, NFKB2, NFKBIA, NHEJ1, NHP2, NLRC4, NLRP1, NLRP12, NLRP3, NOD2, NOP10, NRAS, NSMCE3, OFD1, ORAI1, OTULIN, PARN, PEPD, PGM3, PIGA, PIK3CD, PIK3R1, PLCG2, PMS2, PNP, POLE, POLE2, PRF1, PRKCD, PRKDC, PSENEN, PSMB8, PSTPIP1, PTPRC, RAB27A, RAC2, RAG1, RAG2, RASGRP1, RBCK1, RECQL4, RFX5, RFXANK, RFXAP, RHOH, RLTPR, RMRP, RNASEH2A, RNASEH2B, RNASEH2C, RNF168, RNF31, RNU4ATAC, RORC, RPSA, RTEL1, SAMD9, SAMD9L, SAMHD1, SBDS, SERPING1, SH2D1A, SLC29A3, SLC35C1, SLC37A4, SLC46A1, SLC7A7, SMARCAL1, SMARCD2, SP110, SPINK5, SRP72, STAT1, STAT2, STAT3, STAT5B, STIM1, STK4, STX11, STXBP2, TAP1, TAP2, TAPBP, TBX1, TCF3, TCN2, TERC, TERT, TFRC, THBD, TINF2, TMC6, TMC8, TMEM173, TNFAIP3, TNFRSF13B, TNFRSF1A, TNFRSF4, TRAF3IP2, TREX1, TRNT1, TTC7A, TYK2, UNC119, UNC13D, UNC93B1, UNG, USB1, USP18, VPS13B, VPS45, WAS, WDR1, WIPF1, WRAP53, XIAP, ZAP70, ZBTB24 and ZNF341.