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Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature


Other Names:
CANDLE syndrome; Chronic atypical neutrophilic dermatosis-lipodystrophy-elevated temperature syndrome
Categories:
Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature syndrome (CANDLE syndrome) occurs when the immune system attacks the body by mistake. Symptoms usually develop within the first few months of life and may include recurrent fevers and purple colored spots on the skin particularly around the eyes. Loss of body fat, bone, and joint pain also usually occur. Since so few people have been reported with CANDLE syndrome, it is difficult to know how it affects people in the long term. CANDLE syndrome occurs when the PSMB8 gene is not working correctly. Other genes associated with CANDLE syndrome include PSMB4, PSMA3, and POMP.  It is usually inherited in an autosomal recessive pattern; however, when associated with variants in the POMP gene, may be inherited in an autosomal dominant pattern. There is no specific treatment for this condition; however, steroids may help reduce the frequency of symptoms. 

Last updated: 6/11/2020
The following list includes the most common signs and symptoms in people with chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome. These features may be different from person to person. Some people may have more symptoms than others and symptoms can range from mild to severe. This list does not include every symptom or feature that has been described in this condition.

Signs and symptoms of CANDLE syndrome may include:[1][2]
  • Recurrent fever
  • Muscle wasting
  • Short stature
  • Failure to thrive
  • Loss of body fat (lipodystrophy)
  • Enlarged liver (hepatomegaly)
  • Bone pain
  • Low blood iron (anemia)
The symptoms of CANDLE syndrome usually appear within the first months of life. Initial symptoms include recurrent fevers and skin lesions. Loss of body fat (lipodystrophy) typically begins in early childhood. Bone and joint pain may also occur over time. Very few people have been diagnosed with CANDLE syndrome, so it is not well understood how it changes over time.[1]
Last updated: 6/11/2020

This table lists symptoms that people with this disease may have. For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. This information comes from a database called the Human Phenotype Ontology (HPO) . The HPO collects information on symptoms that have been described in medical resources. The HPO is updated regularly. Use the HPO ID to access more in-depth information about a symptom.

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Medical Terms Other Names
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HPO ID
5%-29% of people have these symptoms
Arrhythmia
Abnormal heart rate
Heart rhythm disorders
Irregular heart beat
Irregular heartbeat
[ more ] 		0011675
Seizure 0001250
Short stature
Decreased body height
Small stature
[ more ] 		0004322
Percent of people who have these symptoms is not available through HPO
Abnormally large globe
Increased size of eyes
Large eyes
[ more ] 		0001090
Adipose tissue loss
Loss of fat tissue
0008887
Anemia
Low number of red blood cells or hemoglobin
0001903
Arthralgia
Joint pain
0002829
Autosomal recessive inheritance 0000007
Basal ganglia calcification 0002135
Bone pain 0002653
Camptodactyly of finger
Permanent flexion of the finger
0100490
Cardiomegaly
Enlarged heart
Increased heart size
[ more ] 		0001640
Clubbing of fingers
Clubbed fingers
Clubbing (hands)
Finger clubbing
[ more ] 		0100759
Congestive heart failure
Cardiac failure
Cardiac failures
Heart failure
[ more ] 		0001635
Conjunctivitis
Pink eye
0000509
Elbow flexion contracture
Contractures of elbows
Elbow contracture
Elbow contractures
[ more ] 		0002987
Elevated erythrocyte sedimentation rate
High ESR
0003565
Elevated hepatic transaminase
High liver enzymes
0002910
Episcleritis
Inflammation of the thin layer on top of the white part of eye
0100534
Erythema 0010783
Failure to thrive
Faltering weight
Weight faltering
[ more ] 		0001508
Finger swelling 0025131
Flexion contracture of toe 0005830
Growth abnormality
Abnormal growth
Growth issue
[ more ] 		0001507
Hepatomegaly
Enlarged liver
0002240
Hyperpigmentation of the skin
Patchy darkened skin
0000953
Hypertriglyceridemia
Increased plasma triglycerides
Increased serum triglycerides
Increased triglycerides
[ more ] 		0002155
Increased circulating antibody level 0010702
Intellectual disability, mild
Mental retardation, borderline-mild
Mild and nonprogressive mental retardation
Mild mental retardation
[ more ] 		0001256
Lipodystrophy
Inability to make and keep healthy fat tissue
0009125
Long fingers 0100807
Lymphadenopathy
Swollen lymph nodes
0002716
Macroglossia
Abnormally large tongue
Increased size of tongue
Large tongue
[ more ] 		0000158
Macrotia
Large ears
0000400
Microcytic anemia 0001935
Muscle weakness
Muscular weakness
0001324
Osteopenia 0000938
Panniculitis
Inflammation of fat tissue
0012490
Prominent nose
Big nose
Disproportionately large nose
Increased nasal size
Increased size of nose
Large nose
Pronounced nose
[ more ] 		0000448
Skeletal muscle atrophy
Muscle degeneration
Muscle wasting
[ more ] 		0003202
Splenomegaly
Increased spleen size
0001744
Stiff skin 0030053
Thick lower lip vermilion
Increased volume of lower lip
Plump lower lip
Prominent lower lip
[ more ] 		0000179
Thrombocytopenia
Low platelet count
0001873
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Last updated: 7/1/2020
Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome occurs when the PSMB8, PSMB4, PSMA3, or POMP gene is not working correctly. DNA changes known as pathogenic variants or mutations are responsible for making genes work incorrectly or sometimes, not at all.[1][2]
Last updated: 6/11/2020
Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome usually inherited in an autosomal recessive pattern.[1][2] All individuals inherit two copies of each gene. Autosomal means the gene is found on one of the numbered chromosomes found in both sexes. Recessive means that both copies of the responsible gene must be altered to have the condition.
  
People with autosomal recessive conditions inherit one alteration from each of their parents. The parents, who each have one gene alteration, are known as carriers.  Carriers of an autosomal recessive condition typically do not have any signs or symptoms (they are unaffected). When two carriers of an autosomal recessive condition have children, there is a 25% (1 in 4) chance to have a child with the condition. 

When CANDLE syndrome is associated with the POMP gene, it can be inherited in an autosomal dominant pattern.

Last updated: 6/11/2020
Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome is diagnosed through a clinical exam, the symptoms, and can be confirmed by genetic testing.[3][4]
Last updated: 6/11/2020

Related diseases are conditions that have similar signs and symptoms. A health care provider may consider these conditions in the table below when making a diagnosis. Please note that the table may not include all the possible conditions related to this disease.

Conditions with similar signs and symptoms from Orphanet
Differential diagnoses include other proteasome disability syndromes as well as CINCA syndrome, panniculitis-induced acquired generalized lipodystrophy, Sweet syndrome (see these terms), and other annular eruptions of infancy and skin involvement as seen in acute myeloid leukemia (see this term).
Visit the Orphanet disease page for more information.

Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the group’s website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

Organizations Supporting this Disease

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

In-Depth Information

  • The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
  • Online Mendelian Inheritance in Man (OMIM) is a catalog of human genes and genetic disorders. Each entry has a summary of related medical articles. It is meant for health care professionals and researchers. OMIM is maintained by Johns Hopkins University School of Medicine. 
  • Orphanet is a European reference portal for information on rare diseases and orphan drugs. Access to this database is free of charge.
  • PubMed is a searchable database of medical literature and lists journal articles that discuss Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature. Click on the link to view a sample search on this topic.

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  1. Torrelo A. CANDLE Syndrome As a Paradigm of Proteasome-Related Autoinflammation. Front Immunol. 2017; 8:927. https://pubmed.ncbi.nlm.nih.gov/28848544.
  2. Boyadzhiev M, Marinov L, Boyadzhiev V, Iotova V, Aksentijevich I, Hambleton S. Disease course and treatment effects of a JAK inhibitor in a patient with CANDLE syndrome. Pediatr Rheumatol Online J. 2019; 17(1):19. https://pubmed.ncbi.nlm.nih.gov/31046790.
  3. Torrelo A, Patel S, Colmenero I, et al. Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome. J Am Acad Dermatol. 2010; 62(3):489-495. https://pubmed.ncbi.nlm.nih.gov/20159315.
  4. Liu Y, Ramot Y, Torrelo A, et al. Mutations in proteasome subunit ß type 8 cause chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature with evidence of genetic and phenotypic heterogeneity. Arthritis Rheum. 2012; 64(3):895-907. https://pubmed.ncbi.nlm.nih.gov/21953331.