# Our Three Musketeers: A Case Series of NLRP-3 Associated Cryopyrinopathies

## TL;DR

This case series highlights three patients with NLRP3-related autoinflammatory diseases, emphasizing the importance of genetic testing and treatment challenges in resource-limited settings.

## Contribution

The study adds novel clinical presentations and treatment insights for NLRP3-associated autoinflammatory diseases through a case series.

## Key findings

- Three patients with NLRP3 cryopyrinopathies presented with varied symptoms including fever, uveitis, and hearing loss.
- Genetic testing should be considered in children with autoinflammatory features and specific clinical signs.
- Current treatments like anakinra have limitations in resource-limited areas, highlighting a need for alternative therapies.

## Abstract

Autoinflammatory diseases affecting the NLRP3 gene are rare autosomal dominant disorders presenting with episodic organ limited and systemic inflammation. We report three patients with cryopyrinopathies. Our first case is a 4-year-old boy with a history of periodic fever, failure to thrive, and raised intracranial pressure. The second case is a 6-year-old boy with similar complaints, also with bilateral uveitis. The third is a 24-year-old gentleman with periodic fever and early hearing loss, also with a novel presentation of sacroiliitis. Our case series demonstrates that there should be a low clinical threshold indicating genetic testing in any child who displays features of autoinflammation in combination with an urticarial rash, musculoskeletal manifestations, hearing loss, and chronic aseptic meningitis with macrocephaly. Furthermore, despite anakinra being a cornerstone in treating NLRP-3 AID, there is an unmet clinical need to provide access to alternatives such as colchicine and thalidomide in resource-limited settings.