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Márquez Balbás G, González-Enseñat MA, Vicente A, Creus-Vila L, Antón J, Umbert-Millet P. Incontinentia pigmenti and bipolar aphthosis: an unusual combination. ISRN DERMATOLOGY 2012; 2011:814186. [PMID: 22363861 PMCID: PMC3262544 DOI: 10.5402/2011/814186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 01/06/2011] [Indexed: 11/23/2022]
Abstract
Incontinentia pigmenti (IP) is an uncommon X-linked dominant multisystem disorder, lethal in the majority of affected males in utero and variably expressed in females. The cutaneous manifestations are diagnostic and classically occur in four stages: vesicular, verrucous, hyperpigmented, and atrophic. The skin lesions are typically spread along the lines of Blaschko, and they are usually present at birth. It may be variably accompanied by dental, ocular, neurologic, bones and joints, and development anomalies. The genes IP has been mapped to Xq28. Mutations in the NEMO/IKKγ gene, located at Xq28, have been found to cause expression of the disease. Behçets disease is a multisystem disorder consisting of recurrent oral aphtae, genital ulcers, pustular skin eruption, and uveitis. Occasionally there are other articular, neurological, intestinal, or vascular abnormalities. This disease is rare in children. Here, we report a case of a 16-year-old female with the rare combination of incontinentia pigmenti and an aphthosis bipolar, and we discuss the probably relationship between these two diseases.
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Affiliation(s)
- G Márquez Balbás
- Servicio Dermatología, Hospital Universitari Sagrat Cor, 08029 Barcelona, Spain
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2
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Ming JE, Stiehm ER. Genetic syndromic immunodeficiencies with antibody defects. Immunol Allergy Clin North Am 2009; 28:715-36, vii. [PMID: 18940571 DOI: 10.1016/j.iac.2008.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This article reviews the major syndromic immunodeficiencies with significant antibody defects, many of which may require intravenous immunogammaglobulin therapy. The authors define syndromic immunodeficiency as an illness associated with a characteristic group of phenotypic abnormalities or laboratory features that comprise a recognizable syndrome. Many are familial with a defined inheritance pattern. Immunodeficiency may not be a major part of the illness and may not be present in all patients; thus, these conditions differ from primary immunodeficiency syndromes, in which immune abnormalities are a consistent and prominent feature of their disease.
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Affiliation(s)
- Jeffrey E Ming
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Senturk N, Aydin F, Haciomeroglu P, Yildiz L, Totan M, Canturk T, Turanli AY. Pulmonary tuberculosis and cutaneous mycobacterial infection in a patient with incontinentia pigmenti. Pediatr Dermatol 2004; 21:660-3. [PMID: 15575852 DOI: 10.1111/j.0736-8046.2004.21610.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lupus vulgaris is reinfection tuberculosis of the skin and may result from direct extension, or hematogenous or lymphatic spread from a tuberculosis focus. Lupus vulgaris following bacille Calmette-Guerin (BCG) vaccination is a rare entity. Incontinentia pigmenti is an X-linked dominant genodermatosis in which vesicular, verrucous, and pigmented lesions are associated with various developmental defects. There is evidence of altered immunologic reactivity in some patients with incontinentia pigmenti. A 12-year-old girl hospitalized for pulmonary tuberculosis presented with bizarre-shaped brown macules following Blaschko lines on the left deltoid area, compatible with incontinentia pigmenti, which had appeared following BCG vaccination at the age of 7 years. Histopathologic examination found noncaseated granulomas in the dermis. Antituberculous treatment for pulmonary and cutaneous tuberculosis was initiated along with genetic counseling. Immunologic abnormalities have been reported in conjunction with incontinentia pigmenti. Simultaneous occurrence of pulmonary and cutaneous tuberculosis in our patient might be either coincidental or indicate derangements in the cellular immune system.
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Affiliation(s)
- Nilgün Senturk
- Department of Dermatology, Faculty of Medicine, Ondokuz Mayis University, 55139 Kurupelit/Samsun, Turkey.
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Aradhya S, Courtois G, Rajkovic A, Lewis RA, Levy M, Israël A, Nelson DL. Atypical forms of incontinentia pigmenti in male individuals result from mutations of a cytosine tract in exon 10 of NEMO (IKK-gamma). Am J Hum Genet 2001; 68:765-71. [PMID: 11179023 PMCID: PMC1274488 DOI: 10.1086/318806] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2000] [Accepted: 01/17/2001] [Indexed: 11/04/2022] Open
Abstract
Familial incontinentia pigmenti (IP [MIM 308310]), or Bloch-Sulzberger syndrome, is an X-linked dominant and male-lethal disorder. We recently demonstrated that mutations in NEMO (IKK-gamma), which encodes a critical component of the NF-kappaB signaling pathway, were responsible for IP. Virtually all mutations eliminate the production of NEMO, causing the typical skewing of X inactivation in female individuals and lethality in male individuals, possibly through enhanced sensitivity to apoptosis. Most mutations also give rise to classic signs of IP, but, in this report, we describe two mutations in families with atypical phenotypes. Remarkably, each family included a male individual with unusual signs, including postnatal survival and either immune dysfunction or hematopoietic disturbance. We found two duplication mutations in these families, at a cytosine tract in exon 10 of NEMO, both of which remove the zinc (Zn) finger at the C-terminus of the protein. Two deletion mutations were also identified in the same tract in additional families. However, only the duplication mutations allowed male individuals to survive, and affected female individuals with duplication mutations demonstrated random or slight skewing of X inactivation. Similarly, NF-kappaB activation was diminished in the presence of duplication mutations and was completely absent in cells with deletion mutations. These results strongly indicate that male individuals can also suffer from IP caused by NEMO mutations, and we therefore urge a reevaluation of the diagnostic criteria.
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Affiliation(s)
- Swaroop Aradhya
- Departments of Molecular & Human Genetics, Pathology, Ophthalmology, and Dermatology, Baylor College of Medicine, Houston; and Unité de Biologie Moléculaire de l’Expression Génetique, URA 1773 CNRS, Institut Pasteur, Paris
| | - Gilles Courtois
- Departments of Molecular & Human Genetics, Pathology, Ophthalmology, and Dermatology, Baylor College of Medicine, Houston; and Unité de Biologie Moléculaire de l’Expression Génetique, URA 1773 CNRS, Institut Pasteur, Paris
| | - Aleks Rajkovic
- Departments of Molecular & Human Genetics, Pathology, Ophthalmology, and Dermatology, Baylor College of Medicine, Houston; and Unité de Biologie Moléculaire de l’Expression Génetique, URA 1773 CNRS, Institut Pasteur, Paris
| | - Richard Alan Lewis
- Departments of Molecular & Human Genetics, Pathology, Ophthalmology, and Dermatology, Baylor College of Medicine, Houston; and Unité de Biologie Moléculaire de l’Expression Génetique, URA 1773 CNRS, Institut Pasteur, Paris
| | - Moise Levy
- Departments of Molecular & Human Genetics, Pathology, Ophthalmology, and Dermatology, Baylor College of Medicine, Houston; and Unité de Biologie Moléculaire de l’Expression Génetique, URA 1773 CNRS, Institut Pasteur, Paris
| | - Alain Israël
- Departments of Molecular & Human Genetics, Pathology, Ophthalmology, and Dermatology, Baylor College of Medicine, Houston; and Unité de Biologie Moléculaire de l’Expression Génetique, URA 1773 CNRS, Institut Pasteur, Paris
| | - David L. Nelson
- Departments of Molecular & Human Genetics, Pathology, Ophthalmology, and Dermatology, Baylor College of Medicine, Houston; and Unité de Biologie Moléculaire de l’Expression Génetique, URA 1773 CNRS, Institut Pasteur, Paris
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Abstract
We studied eight patients with incontinentia pigmenti to investigate the possibility of immunologic abnormalities. In six patients a defect of polymorphonuclear chemotaxis was revealed; lymphocyte subpopulations, serum immunoglobulin levels, and peripheral eosinophils were within normal limits. We hope these findings will stimulate further investigations into the mechanisms involved.
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Affiliation(s)
- S Menni
- Institute of Dermatologic Clinic 1st, University of Milan, Italy
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7
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Abstract
Three women subsequently shown to have incontinentia pigmenti (IP) presented with white hairless streaks on the limbs as the predominant cutaneous abnormality. Seven other patients with IP diagnosed in infancy were reviewed to establish the frequency of this sign. It was found in all of them, and in the otherwise unaffected mother of three affected girls. A focal absence of sweating in these lesions is reported here for the first time. There are other similarities with anhidrotic ectodermal dysplasia, suggesting a genetic overlap between these two X-linked conditions.
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Wettke-Schäfer R, Kantner G. X-linked dominant inherited diseases with lethality in hemizygous males. Hum Genet 1983; 64:1-23. [PMID: 6873941 DOI: 10.1007/bf00289472] [Citation(s) in RCA: 121] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
X-linked dominant inheritance with lethality in hemizygous males is a rare mode of inheritance. The three best-known disorders which seem to be inherited in this way, are incontinentia pigmenti (IP) Bloch-Sulzberger, oral-facial-digital I (OFD I) syndrome, and focal dermal hypoplasia (FDH syndrome, Goltz syndrome). It is the purpose of this article to give a review of the clinical and genetic aspects of the above-mentioned diseases and to add those disorders in which this mode of inheritance is discussed. These disorders are: X-linked chondrodysplasia punctata (CP), cervico-oculo-acusticus syndrome (Wildervanck syndrome, COA), congenital cataract with microcornea or slight microphthalmia, muscular dystrophy--hemizygous lethal, partial lipodystrophy with lipatrophic diabetes and hyperlipidemia, Aicardi syndrome, coxo-auricular syndrome, and Johanson-Blizzard syndrome. OTC deficiency is included in the study, although there is no lethality in utero, only in the neonatal period. A critical evaluation of the current literature is carried out.
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MESH Headings
- Abnormalities, Multiple/genetics
- Abnormalities, Multiple/mortality
- Abnormalities, Multiple/pathology
- Amino Acid Metabolism, Inborn Errors/genetics
- Amino Acid Metabolism, Inborn Errors/mortality
- Amino Acid Metabolism, Inborn Errors/pathology
- Aneuploidy
- Child
- Female
- Genes, Dominant
- Genetic Counseling
- Genetic Diseases, Inborn/genetics
- Genetic Diseases, Inborn/mortality
- Genetic Diseases, Inborn/pathology
- Humans
- Infant
- Infant, Newborn
- Male
- Nevus, Pigmented/genetics
- Nevus, Pigmented/mortality
- Nevus, Pigmented/pathology
- Ornithine Carbamoyltransferase Deficiency Disease
- Orofaciodigital Syndromes/genetics
- Orofaciodigital Syndromes/mortality
- Orofaciodigital Syndromes/pathology
- Pedigree
- Pigmentation Disorders/genetics
- Pigmentation Disorders/mortality
- Pigmentation Disorders/pathology
- Sex Chromosome Aberrations/genetics
- Sex Chromosome Aberrations/mortality
- Sex Chromosome Aberrations/pathology
- Skin Diseases/genetics
- Skin Diseases/mortality
- Skin Diseases/pathology
- Syndrome
- X Chromosome
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Kurczynski TW, Berns JS, Johnson WE. Studies of a family with incontinentia pigmenti variably expressed in both sexes. J Med Genet 1982; 19:447-51. [PMID: 7154043 PMCID: PMC1048960 DOI: 10.1136/jmg.19.6.447] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A family is described in which incontinentia pigmenti (IP) is variably expressed in both sexes, compatible with either autosomal dominant or X linked dominant inheritance. This is the first reported instance of an affected male with a positive family history. Immunological studies of the proband showed no significant alteration of immune function. Cytogenetic investigations of the proband and her affected brother and mother revealed no unusual propensity for chromosome breaks or gaps and no enhancement of sister chromatid exchanges.
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