The nucleotide-binding oligomerization domain 2 (NOD2) is an intracellular pattern recognition receptor. NOD2 gene variants are associated with inflammatory bowel disease (IBD) as well as Blau and Yao syndromes. IBD is associated with extraintestinal manifestations, including autoinflammation, which may be the presenting symptoms. The clinical symptoms may depend on the specific gene variants. This retrospective study was undertaken to examine the clinical manifestations of patients with pathogenic NOD2 variants in our institution. This study was approved by our Institutional Review Board.From January 2020 to February 2022, we identified 203 patients that had genetic testing that included the NOD2 gene. Forty-one had high risk alleles variants (HRA) that segregated in three mutations: HRA1 c.2104C>T (n = 24); HRA2 c.3019dup (n = 11); and HRA3 c.2722G > C (n = 6).The reported age of initial symptoms ranged from 21 days to 62 years, with most patients being < 12 years of age. All three variants had clinical evidence of immune dysregulation. Common manifestations (listed respectively for the three variants) included asthma (HRA1 = 21%, HRA2 = 9%, HRA3 = 33%), reflux/gastritis (29%, 18%, 33%), irritable bowel syndrome (21%, 18%, 7%), chronic diarrhea (8%, 18%, 0%), IBD (13%, 27%, 50%), recurrent fevers (38%, 45%, 0%), cytokine storm (4%, 9%, 17%), arthralgia/arthritis (33%, 45%, 17%), skin rashes (42%, 36%, 0%), malignancy (13%, 0%, 17%), bacterial infections (38%, 36%, 67%), fungal infections (4%, 18%, 0%), other autoimmune (21%, 9%, 0%), autoinflammatory syndromes (13%, 45%, 0%). Autoinflammatory/autoimmune disorders diagnosed within the cohort included PFAPA (HRA1 = 0, HRA2 = 1, HRA3 = 0), Yao syndrome (1, 0, 0), juvenile idiopathic arthritis (1, 1, 0), SAPHO syndrome (0, 1, 0), relapsing polychondritis (0,1,0), lupus (0,1,0), Sjogren’s syndrome (0,1,0), Raynaud’s syndrome (1, 0, 0), vitiligo (0, 1, 0), type I diabetes (2, 0, 0) and hypothyroidism (2, 1, 0). Detailed information is in table 1.Our chart review demonstrates a broad spectrum of extraintestinal clinical manifestations of patients with NOD2 variants which do not always include IBD. NOD2 is important in the protection of infection and autoinflammation and its role in human disease needs to be examined further.
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