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Interleukin-10 receptor mutations in children with neonatal-onset Crohn’s disease and intractable ulcerating enterocolitis

Shim, Jung Oka; Hwang, Solhaa; Yang, Hye Rana; Moon, Jin Sooa; Chang, Ju Younga; Ko, Jae Sunga; Park, Sung Supb; Kang, Gyeong-Hoonc; Kim, Woo Sund; Seo, Jeong Keea

European Journal of Gastroenterology & Hepatology: October 2013 - Volume 25 - Issue 10 - p 1235–1240
doi: 10.1097/MEG.0b013e328361a4f9
Case Report
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Neonatal-onset inflammatory bowel disease (IBD) accounts for only 0.25% of pediatric IBD cases. The molecular pathogenesis of IBD remains unclear. Recently, rare Mendelian mutations have been identified in children with very early-onset Crohn’s disease and ulcerative colitis. In this study, we report compound heterozygous mutations in the interleukin-10 receptor A (IL-10RA) gene in children with severe neonatal-onset IBD. Patient 1 had chronic diarrhea within the first month of life and had perianal fistulae. She was diagnosed with ‘intractable ulcerating enterocolitis in infancy’ and underwent subtotal colectomy at the age of 24 months because of poor response to immunosuppressant therapy. Compound heterozygous mutations, c.[301C>T];[350G>A](p.[R101W];[R117H]), were discovered in IL-10RA for this patient. Patient 2 presented symptoms within the first month of life and was diagnosed with Crohn’s disease. Severe colitis and perianal and enteroenteric fistulae occurred repeatedly, and he underwent surgical management involving colectomy, colostomy, and ileostomy. We identified mutations in IL-10RA, c.[272A>G];[784C>T] (p.[Y91C];[R262C]). Patient 3 had chronic diarrhea and a rectovaginal fistula at 3 days of life and was diagnosed with Crohn’s disease. She underwent fistulectomy and ileostomy, but experienced frequent relapses. Mutations, c.[272A>G];[301C>T] (p.[Y91C];[R101W]), were found in IL-10RA. This report confirms the genetic defect of IL-10RA in neonatal-onset IBD including ‘intractable ulcerating enterocolitis in infancy’.

aDepartment of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition

Departments of bLaboratory Medicine

cPathology

dRadiology, Seoul National University College of Medicine, Seoul, Korea

Correspondence to Jeong Kee Seo, MD, PhD, Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Seoul National University College of Medicine, 28 Yongun-Dong, Jongno-Gu, Seoul 110-769, Korea Tel: +82 2 2072 3627; fax: +82 2 743 3455; e-mail; jkseo@snu.ac.kr

Received January 18, 2013

Accepted March 27, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins