The study will evaluate patients with hyperimmunoglobulin E (HIE) recurrent infection in order to characterize the medical problems associated with this rare inherited disease, identify and treat complications, and do tests to identify the gene, or genes responsible for it. People with HIE have recurrent bacterial (staphylococcal) infections of the ears, sinuses, lungs or skin and elevated levels of the antibody immunoglobulin E. They may also have scoliosis (curvature of the spine), weak bones and recurrent bone fractures, strokes or other brain problems, severe itching and skin inflammation, and problems with baby teeth not falling out.

Patients of any age with HIE syndrome and their relatives may participate in this study. Patients will be evaluated by specialists in genetics, dermatology, bone metabolism, dental, radiology, neurology and immunology. Specific procedures may include the following:

1. Medical history and physical examination
2. Blood and urine collection for routine tests
3. Blood collection for chromosome study, for DNA (genetic) testing and for growing certain cell lines that, with special care, will not die so they can be used for testing later
4. Skin examination
5. Family history interview with genetics specialists
6. Neurology examination to test reflexes, strength, balance and movement
7. Magnetic resonance imaging (MRI) of the brain
8. Dental examination and X-rays, if needed, to look for abnormal loss or retention of baby teeth
9. Computed tomography (CT) scan of the chest to examine the lungs
10. Skeletal survey, including X-rays of the spine and several joints, bone densitometry (test to measure bone density), blood and urine tests to measure substances that indicate how fast new bone is made
11. Pulmonary function test, using a breathing machine to see what volume of air the lungs can hold
12. Skin biopsy (removal of small sample of skin tissue, under local anesthetic, for microscopic testing) for gene research purposes
13. Bone biopsy (removal of small sample of bone tissue from the hip, under local anesthetic, for microscopic examination) for research on bone fractures

Patients will be followed once a year for five years. At each visit, they will have a MRI scan of the brain, CT scan of the chest, bone densitometry test, skin examination and dental examination. Patients with scoliosis will all have spine films.

Family members will have a physical examination, an interview with genetics specialists, and blood tests for cell counts, measurement of immunoglobulin E, and genetic studies. Some family members will also have cell lines made.

Hyper IgE Syndrome (HIE) is an autosomal dominant disorder caused primarily by STAT3 mutations with extensive skeletal and connective tissue manifestations. Whether STAT3 is the only genetic etiology remains unknown, as well as the etiology of related disorders, such as autosomal recessive Hyper IgE Syndrome. HIE affects a large number of tissues and functions, and is critical to our complete understanding of bone metabolism, bronchiectasis, dental maturation, and stroke. Therefore, we seek to enroll patients and families with a confirmed or suspected diagnosis of HIE (Job) syndrome for extensive phenotypic and genotypic study as well as disease management. Patients will be carefully examined by a multidisciplinary team and followed longitudinally. Through these studies we hope to better characterize the clinical presentation of HIE and to be able to identify further genetic etiologies, as well as understand the pathogenesis of HIE. We seek to enroll 100 patients and 300 relatives.

• Bale JF Jr, Wilson JF, Hill HR. Fatal histiocytic lymphoma of the brain associated with hyperimmunoglobulinemia-E and recurrent infections. Cancer. 1977 Jun;39(6):2386-90.
• Blum R, Geller G, Fish LA. Recurrent severe staphylococcal infections, eczematoid rash, extreme elevations of IgE, eosinophilia, and divergent chemotactic responses in two generations. J Pediatr. 1977 Apr;90(4):607-9. No abstract available.
• Buckley RH, Wray BB, Belmaker EZ. Extreme hyperimmunoglobulinemia E and undue susceptibility to infection. Pediatrics. 1972 Jan;49(1):59-70. No abstract available.

• INCLUSION CRITERIA:

Patients must be referred to the NIH with a diagnosis or a suspicion of the Job syndrome. Family members of probands and patients referred for other immune syndromes that demonstrate some the characteristics of Job's syndrome may also be evaluated under this protocol.

Male and female patients will be accepted.

EXCLUSION CRITERIA:

Pregnant women are excluded only from any procedure or test that may endanger the pregnancy or the fetus due to the risk from radiographic studies, anesthesia, or certain biopsies.

Coronary CT angiography will not be performed on any patient with contraindication to IV contrast media. This includes patients with: 1) creatinine value of greater than 1.3 mg/dl, 2) history of multiple myeloma, 3) use of metformin-containing products less than 24 hours prior to contrast media, and 4) history of significant allergic reaction to CT contrast agents despite the use of premedication.