CONTEXT: Chédiak-Higashi Syndrome (CHS) is a rare autosomal recessive disease characterized by recurrent infections, giant cytoplasmic granules, and oculocutaneous albinism. OBJECTIVE: To describe clinical and laboratory findings from CHS patients. DESIGN: Case report. SETTING: The patients were admitted into the Allergy and Immunology Unit of the Instituto da Criança, a tertiary public care institution. CASES REPORT: Seven patients had oculocutaneous albinism, recurrent infections and giant cytoplasmic granules in the leukocytes. One patient had low IgG levels and three showed impaired bactericidal activity of neutrophils. Six patients died of infectious complications during the accelerated phase. Therapy included ascorbic acid and antibiotics. Chemotherapy was used for the accelerated phase in two patients. Bone marrow transplantation (BMT) was proposed for one patient. DISCUSSION: The authors emphasize the need for early diagnosis and therapy of CHS. BMT should be indicated before the accelerated phase of the disease has developed.
CONTEXTO: A Síndrome de Chédiak-Higashi (SCH) é uma doença autossômica recessiva rara, caracterizada por infecções de repetição, grânulos citoplasmáticos gigantes e albinismo óculo-cutâneo. OBJETIVO: Descrever os achados clínico-laboratoriais de pacientes portadores de SCH. TIPO DE ESTUDO: Relato de caso. LOCAL: Unidade de Alergia e Imunologia do Instituto da Criança, uma Instituição pública de cuidados terciários. PACIENTES: Os sete pacientes apresentavam albinismo óculo-cutâneo, infecções de repetição e grânulos gigantes citoplasmáticos em leucócitos. Um paciente apresentou níveis séricos diminuídos de IgG e três apresentavam capacidade bactericida de neutrófilos reduzida. Seis pacientes faleceram durante infecção, na fase acelerada. A terapêutica incluiu ácido ascórbico e antibioticoterapia. A quimioterapia foi aplicada em dois pacientes na fase acelerada. O transplante de medula óssea (TMO) foi proposto para um paciente. DISCUSSÃO: Os autores ressaltam o diagnóstico precoce e o tratamento da SCH. O transplante de medula óssea deve ser indicado antes da fase acelerada da doença.
The few studies already published about phagocyte functions in Chediak-Higashi syndrome (CHS) has stated that neutrophils present slow rate of bacterial killing but normally ingest microorganisms. In the present study, both phagocytosis and killing of Staphylococcus aureus were verified to be in neutrophils from two patients with CHS when these functions were simultaneously evaluated by a fluorochrome phagocytosis assay. Electron microscopic examination showed morphologic differences among neutophils from CHS patients and normal neutrophils regarding the cytoplasmic structures and the aspects of the phagolysosomes. It was noteworthy the presence of giant phagolysosomes enclosing bacteria in active proliferation commonly observed in CHS neutrophils after 45 min of phagocytosis, wich corresponded with the impaired bactericidal activity of these leukocytes. The present results suggest that phagocytosis may also be defective in CHS, and point out to the sensitivity of the fluorochrome phagocytosis assay and its application in clinical laboratories.