Saniya I. Valieva
, Seda Kh. Kurbanova
, Anna S. Sologub
, Ivan R. Gaziev
, Dmitry Yu. Ovsyannikov
Abstract
A clinical case of an infant patient with orphan autoinflammatory syndrome, Blau syndrome, is presented. The issues of pathogenesis, genetics, clinical symptoms, laboratory and instrumental characteristics, as well as management tactics for patients with this pathology are considered.
The analysis of the presented clinical observation illustrates the difficulties of diagnosis and therapy of Blau syndrome.
Keywords: Blau syndrome, autoinflammatory diseases, genetics, children.
The analysis of the presented clinical observation illustrates the difficulties of diagnosis and therapy of Blau syndrome.
Keywords: Blau syndrome, autoinflammatory diseases, genetics, children.
About the Author
Saniya I. Valieva , Saniya I. Valieva , Seda Kh. Kurbanova , Anna S. Sologub , Ivan R. Gaziev , Dmitry Yu. Ovsyannikov , Dmitry Yu. Ovsyannikov
Saniya I. Valieva1,2, Seda Kh. Kurbanova1, Anna S. Sologub1, Ivan R. Gaziev1, Dmitry Yu. Ovsyannikov1,3
1 Morozovskaya Children’s City Clinical Hospital, Moscow, Russia;
2 Pirogov Russian National Research Medical University, Moscow, Russia;
3 Patrice Lumumba Peoples' Friendship University of Russia, Moscow, Russia
1 Morozovskaya Children’s City Clinical Hospital, Moscow, Russia;
2 Pirogov Russian National Research Medical University, Moscow, Russia;
3 Patrice Lumumba Peoples' Friendship University of Russia, Moscow, Russia
References
1. Zeybek C, Basbozkurt G, Gul D et al. A New Mutation in Blau Syndrome. Case Rep Rheumatol 2015;(2015):463959. DOI: 10.1155/2015/463959
2. Ong LT, Nachbur U, Rowczenio D et al. A novel nucleotide oligomerisation domain 2 mutation in a family with Blau syndrome: Phenotype and function. Innate Immun 2017;23(7):578-83. DOI: 10.1177/1753425917727063
3. Lu L, Shen M, Jiang D et al. Blau syndrome with good Reponses to Tocilizumab: A case report and focused literature review. Semin Arthritis Rheum 2018;47(5):727-31. DOI: 10.1016/j.semarthrit.2017.09.010
4. Kaufman KP, Becker ML. Distinguishing Blau Syndrome from Systemic Sarcoidosis. Curr Allergy Asthma Rep 2021;21(2):10. DOI: 10.1007/s11882-021-00991-3
5. Takada S, Saito MK, Kambe N. Blau Syndrome: NOD2-related systemic autoinflammatory granulomatosis. G Ital Dermatol E Venereol 2020;155(5):537-41. DOI: 10.23736/S0392-0488.19.06524-6
6. Holland GN, Rosenbaum JT. The Challenge of Blau Syndrome. Am J Ophthalmol 2018;(187):xviii-xix. DOI: 10.1016/j.ajo.2017.12.006
7. Imayoshi M, Ogata Y, Yamamoto S. A Case of Sporadic Blau Syndrome with an Uncommon Clinical Course. Case Rep Rheumatol 2018;(2018):6292308. DOI: 10.1155/2018/6292308
8. Rose CD. Blau Syndrome: A Systemic Granulomatous Disease of Cutaneous Onset and Phenotypic Complexity. Pediatr Dermatol 2017;34(2):216-8. DOI: 10.1111/pde.13021
9. Parkhouse R, Boyle JP, Monie TP. Blau syndrome polymorphisms in NOD2 identify nucleotide hydrolysis and helical domain 1 as signalling regulators. FEBS Lett 2014;588(18):3382-9. DOI: 10.1016/j.febslet.2014.07.029
10. Yao Q, Li E, Shen B. Autoinflammatory disease with focus on NOD2-associated disease in the era of genomic medicine. Autoimmunity 2019;52(2):48-56. DOI: 10.1080/08916934.2019.1613382
11. Sfriso P, Caso F, Tognon S et al. Blau syndrome, clinical and genetic aspects. Autoimmun Rev 2012;12(1):44-51. DOI: 10.1016/j.autrev.2012.07.028
12. Khubchandani RP, Hasija R, Touitou I et al. Blau arteritis resembling Takayasu disease with a novel NOD2 mutation. J Rheumatol 2012;39(9):1888-92. DOI: 10.3899/jrheum.120156
13. Rose CD, Pans S, Casteels I et al. Blau syndrome: cross-sectional data from a multicentre study of clinical, radiological and functional outcomes. Rheumatology 2015;54(6):1008-16. DOI: 10.1093/rheumatology/keu437
14. Jindal AK, Pilania RK, Suri D et al. A young female with early onset arthritis, uveitis, hepatic, and renal granulomas: a clinical tryst with Blau syndrome over 20 years and case-based review. Rheumatol Int 2021;41(1):173-81. DOI: 10.1007/s00296-019-04316-6
15. Sarens IL, Casteels I, Anton J et al. Blau Syndrome–Associated Uveitis: Preliminary Results From an International Prospective Interventional Case Series. Am J Ophthalmol 2018;(187):158-66. DOI: 10.1016/j.ajo. 2017.08.017
16. Aróstegui JI, Arnal C, Merino R et al. NOD2 gene-associated pediatric granulomatous arthritis: clinical diversity, novel and recurrent mutations, and evidence of clinical improvement with interleukin-1 blockade in a Spanish cohort. Arthritis Rheum 2007;56(11):3805-13. DOI: 10.1002/art.22966
17. Rose CD, Martin TM, Wouters CH. Blau syndrome revisited. Curr Opin Rheumatol 2011;23(5):411-8. DOI: 10.1097/BOR.0b013e328349c430
18. Poline J, Bourrat E, Meinzer U. Camptodactlyly in Pediatric Practice: Blau Syndrome. J Pediatr 2020;(221):257-9. DOI: 10.1016/j.jpeds.2020.01.057
19. Poline J, Fogel O, Pajot C et al. Early-onset granulomatous arthritis, uveitis and skin rash: characterization of skin involvement in Blau syndrome. J Eur Acad Dermatol Venereol JEADV 2020;34(2):340-8. DOI: 10.1111/jdv.15963
20. Федоров Е.С., Салугина С.О., Шаповаленко А.Н. и др. Синдром Блау, или моногенный саркоидоз с ранним началом: российская когорта пациентов. Педиатрия. Журнал им. Г.Н. Сперанского. 2021;100(5):99-109. DOI: 10.24110/0031-403X-2021-100-5-99-109
Fedorov E.S., Salugina S.O., Shapovalenko A.N., et al. Blau syndrome, or early-onset monogenic sarcoidosis: a Russian cohort of patients. Pediatrics. Speransky Journal. 2021;100(5):99-109. DOI: 10.24110/0031-403X-2021-100-5-99-109 (in Russian).
21. Kreps EO, Al Julandani D, Guly CM et al. Long-Term Visual Outcome of Patients with Blau Syndrome. Ocul Immunol Inflamm 2024;32(8):1728-32. DOI: 10.1080/09273948.2023.2293922
22. Sinharay R, McKeown L, Phillips C et al. First report of liver transplantation in Blau syndrome: The challenges faced in this rare granulomatous liver disease. Transpl Immunol 2021;(65):101378. DOI: 10.1016/j.trim. 2021.101378
23. Wu D, Shen M. Two Chinese pedigrees of Blau syndrome with thirteen affected members. Clin Rheumatol 2018;37(1):265-70. DOI: 10.1007/s10067-017-3758-7
24. Jain L, Gupta N, Reddy MM et al. A Novel Mutation in Helical Domain 2 of NOD2 in Sporadic Blau Syndrome. Ocul Immunol Inflamm. 2018;26(2):292-4. DOI: 10.1080/09273948.2016.1207789
25. Zhong L, Wang W, Tang X et al. Phenotype of Takayasu-like vasculitis and cardiopathy in patients with Blau syndrome. Clin Rheumatol 2024;43(3):1171-81. DOI: 10.1007/s10067-024-06876-w
26. Yao F, Tan B, Wu D, Shen M. Blau syndrome with hypertension and hepatic granulomas: a case report and literature review. Front Pediatr 2023;(11):1063222. DOI: 10.3389/fped.2023.1063222
27. Su J, Liu D. Blau syndrome with pulmonary nodule in a child. Australas J Dermatol 2021;62(2):217-20. DOI: 10.1111/ajd.13551
28. Matsuda T, Kambe N, Takimoto-Ito R et al. Potential Benefits of TNF Targeting Therapy in Blau Syndrome, a NOD2-Associated Systemic Autoinflammatory Granulomatosis. Front Immunol 2022;(13):895765. DOI: 10.3389/fimmu.2022.895765
29. Marín-Noriega MA, Muñoz-Ortiz J, Mosquera C, de-la-Torre A. Ophthalmological treatment of early-onset sarcoidosis/Blau syndrome in a Colombian child: A case report. Am J Ophthalmol Case Rep 2020;(18):100714. DOI: 10.1016/j.ajoc.2020.100714
30. Maccora I, Wouters C, Rosè CD et al. Treatment of uveitis in Blau syndrome: A systematic review and meta-analysis. J Autoimmun 2025;(153):103401. DOI: 10.1016/j.jaut.2025.103401
31. Nascimento H, Sousa JM, Fernández DG et al. Blau-Jabs Syndrome in a Tertiary Ophthalmologic Center. Ophthalmic Surg Lasers Imaging Retina 2018;49(1):70-5. DOI: 10.3928/23258160-20171215-12
32. Babu K, Rao AP. Clinical Profile in Genetically Proven Blau Syndrome: A Case Series from South India. Ocul Immunol Inflamm 2021;29(2):250-6. DOI: 10.1080/09273948.2020.1746353
33. Millington GWM, Dobson J, Holden S et al. Sporadic Blau syndrome treated with adalimumab. Clin Exp Dermatol 2019;44(7):811-3. DOI: 10.1111/ced.14016
34. PaÇ Kisaarslan A, SÖzerÝ B, ÞahÝn N et al. Blau Syndrome and Early-Onset Sarcoidosis: A Six Case Series and Review of the Literature. Arch Rheumatol 2020;35(1):117-27. DOI: 10.5606/ArchRheumatol.2020.7060
35. Kumrah R, Pilania RK, Menia NK et al. Blau syndrome: Lessons learned in a tertiary care centre at Chandigarh, North India. Front Immunol 2022;(13):932919. DOI: 10.3389/fimmu.2022.932919
36. Wang W, Wang W, Zhong LQ et al. Thalidomide may be an effective drug for Blau syndrome: a case report. Ann Palliat Med 2022;11(7):2538-43. DOI: 10.21037/apm-21-2216
37. Yasui K, Yashiro M, Tsuge M et al. Thalidomide dramatically improves the symptoms of early-onset sarcoidosis/Blau syndrome: its possible action and mechanism. Arthritis Rheum 2010;62(1):250-7. DOI: 10.1002/ art.25035
38. Sidiqi A, Pegado V. Blau syndrome following a bacterial infection. J AAPOS 2020;24(2):118-20. DOI: 10.1016/j.jaapos.2019.12.008
39. Soper JR, Bonar SF, O’Sullivan DJ et al. Thalidomide and neurotrophism. Skeletal Radiol 2019;48(4):517-25. DOI: 10.1007/s00256-018-3086-2
40. Nagakura T, Wakiguchi H, Kubota T et al. Tumor Necrosis Factor Inhibitors Provide Longterm Clinical Benefits in Pediatric and Young Adult Patients with Blau Syndrome. J Rheumatol 2017;44(4):536-8. DOI: 10.3899/jrheum.160672
41. Chen J, Luo Y, Zhao M et al. Effective treatment of TNFα inhibitors in Chinese patients with Blau syndrome. Arthritis Res Ther 2019;21(1):236. DOI: 10.1186/s13075-019-2017-5
42. Naik A, Annamalai R, Biswas J. Uveitis in sporadic Blau syndrome: Long-term follow-up of a refractory case treated successfully with adalimumab. Indian J Ophthalmol 2018;66(10):1483. DOI: 10.4103/ijo.IJO_629_18
43. Caracseghi F, Izquierdo-Blasco J, Sanchez-Montanez A et al. Etanercept-induced myelopathy in a pediatric case of blau syndrome. Case Rep Rheumatol 2011;(2011):134106. DOI: 10.1155/2011/134106
44. Simonini G, Xu Z, Caputo R et al. Clinical and transcriptional response to the long-acting interleukin-1 blocker canakinumab in Blau syndrome-related uveitis. Arthritis Rheum 2013;65(2):513-8. DOI: 10.1002/art.37776
45. Martin TM, Zhang Z, Kurz P et al. The NOD2 defect in Blau syndrome does not result in excess interleukin-1 activity. Arthritis Rheum 2009;60(2):611-8. DOI: 10.1002/art.24222
46. Zhang S, Cai Z, Mo X, Zeng H. Tofacitinib effectiveness in Blau syndrome: a case series of Chinese paediatric patients. Pediatr Rheumatol 2021;19(1):160. DOI: 10.1186/s12969-021-00634-x
47. Zhong Z, Dai L, Ding J et al. Molecular diagnostic yield for Blau syndrome in previously diagnosed juvenile idiopathic arthritis with uveitis or cutaneous lesions. Rheumatology 2024;63(SI2):SI260-SI268. DOI: 10.1093/rheumatology/kead596
48. Cho K, Yoon Y, Choi J-sik et al. A Boy With Blau Syndrome Misdiagnosed as Refractory Kawasaki Disease. Pediatr Infect Vaccine 2022;29(3):166. DOI: 10.14776/piv.2022.29.e22
49. Córdova-Fletes C, Rangel-Sosa MM, Martínez-Jacobo LA et al. Whole-exome sequencing in three children with sporadic Blau syndrome, one of them co-presenting with recurrent polyserositis. Autoimmunity 2020;53(6):344-52. DOI: 10.1080/08916934.2020.1786068
50. Whyte MP, Lim E, McAlister WH et al. Unique Variant of NOD2 Pediatric Granulomatous Arthritis With Severe 1,25-Dihydroxyvitamin D-Mediated Hypercalcemia and Generalized Osteosclerosis. J Bone Miner Res 2018;33(11):2071-80. DOI: 10.1002/jbmr.3532
51. Валиева С.И., Курбанова С.Х., Овсянников Д.Ю. Современные представления о моногенных аутовоспалительных заболеваниях. Педиатрия. Журнал им. Г.Н. Сперанского. 2024;103(6):172-82. DOI: 10.24110/0031-403X-2024-103-6-172-182
Valieva S.I., Kurbanova S.Kh., Ovsyannikov D.Yu. Modern ideas about monogenic autoinflammatory diseases. Pediatrics. Journal named after G.N. Speransky. 2024;103(6):172-82. DOI: 10.24110/0031-403X-2024-103-6-172-182 (in Russian).
For citation:Valieva S.I., Kurbanova S.Kh., Sologub A.S., Gaziev I.R., Ovsyannikov D.Yu. Diagnostic challenges in Blau syndrome: case report of pediatric patient with confirmed NOD2 gene mutation. Clinical review for general practice. 2025; 6 (11): 27–33 (In Russ.). DOI: 10.47407/kr2025.6.11.00707
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