Multiple autoimmune phenomena preceding a lymphoproliferative disorder.

Karunatilake and Pidcock [1] recently described an interesting patient with autoimmune manifestations, cytopenias and lymphoproliferation. However, the authors did not comment on several important aspects. Did the patient have any lymphadenopathy, and was there a family history of a similar condition? Was the presence of double negative T cells in the peripheral blood looked for, was an aptotosis assay done, and if abnormal, were relevant Fas pathway gene defects looked for? The patient described may in fact have had the autoimmune lymphoproliferative syndrome (ALPS).