Pediatria Polska

Abstract

1/2026 vol. 101
Case report

The case of a patient with familial cold autoinflammatory syndrome-2 caused by the NLRP12 mutation associated with severe polyarthritis

  1. Department of Clinical Immunology, Institute of Pediatrics, Jagiellonian University Medical College, Cracow, Poland
  2. Department of Clinical Immunology, Children’s University Hospital, Cracow, Poland
Pediatr Pol 2026; 101 (1): 81-86
Online publish date: 2026/03/16
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Familial cold autoinflammatory syndrome-2 (FCAS2) is a rare autosomal dominant disorder caused by pathogenic variants in the NLRP12 gene. It is characterized by recurrent non-pruritic urticaria, arthritis, fever, and elevated inflammatory markers, often triggered by cold exposure. Here, we describe a Polish patient with FCAS2 linked to the NLRP12 c.1054C>T (p.Arg352Cys) variant, who developed severe polyarthritis mimicking juvenile idiopathic arthritis (JIA), yet without fever. Urticarial rashes began at 8 months of age and were initially unrelated to cold, but later became cold-induced. Standard therapies with antihistaminic drugs for urticaria and methotrexate for JIA were ineffective. Due to persistent arthritis and high inflammatory markers, anti-IL-1 therapy (anakinra) was initiated, leading to marked clinical and laboratory improvement, confirming the autoinflammatory mechanism. This case broadens the knowledge of NLRP12-related syndromes and underlines the value of genetic testing in atypical arthritis unresponsive to standard treatment.
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