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Arline Diana I, Tan EC, Gondokaryono SP, Koh MJA, Dwiyana RF, Rahardja JI, Yogya Y, Rafi'ee K, Suwarsa O. Phenotype and genotype correlation of inherited epidermolysis bullosa in Indonesia. Australas J Dermatol 2023; 64:e327-e332. [PMID: 37452458 DOI: 10.1111/ajd.14121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/20/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Inherited epidermolysis bullosa (EB) is a group of genodermatoses with considerable clinical and genetic heterogeneity. Clinical diagnosis of the EB subtypes is frequently imprecise and requires confirmation with genetic testing. There is still limited study using genetic testing to identify EB subtypes in Indonesia. This study aims to identify the pathogenic variants of inherited EB patients at the Department of Dermatology and Venereology, Universitas Padjadjaran-Dr Hasan Sadikin General Hospital in Bandung, West Java, Indonesia and to describe the correlation between the phenotype and genotype of our patients. METHODS Twelve patients clinically diagnosed with EB were included in this study. Genetic testing was performed in collaboration with KK Women's and Children's Hospital, Singapore. RESULTS Pathogenic variants were identified in the COL7A1 gene in seven patients, namely Dominant Dystrophic EB (DDEB) with mutation types c.5945G>T, c.6218G>A, Recessive Dystrophic EB (RDEB) c.2005C>T, c.6081dup, c.1268C>T, c.1784C>T which are all known mutations. Novel mutations were found in the COL7A1 gene in two patients namely DDEB c.6253G>T and RDEB c.6740C>T. Two EB Simplex (EBS) patients showed mutation KRT14 gene as c.356T>C, c.373C>T which are known mutation. In addition, a novel mutation in LAMA3 gene c.2649del was found in one Junctional EB (JEB) patient. CONCLUSION The molecular diagnoses of 12 Indonesian EB patients were identified, of which three were novel pathogenic variants. Concordance between the initial clinical diagnosis and genetic testing was only 33%. This demonstrated the importance of early genetic testing for accurate diagnosis, prognostication, management and genetic counselling.
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Affiliation(s)
- Inne Arline Diana
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Ene-Choo Tan
- Research Laboratory, KK Women's & Children Hospital, Singapore, Singapore
| | - Srie Prihianti Gondokaryono
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Mark Jean-Aan Koh
- Department of Dermatology, KK Women's & Children's Hospital, Singapore, Singapore
| | - Reiva Farah Dwiyana
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - July Iriani Rahardja
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Yuri Yogya
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Khadijah Rafi'ee
- Research Laboratory, KK Women's & Children Hospital, Singapore, Singapore
| | - Oki Suwarsa
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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Tan EC, Chia SY, Rafi'ee K, Lee SX, Kwek ABE, Tan SH, Ng VWL, Wei H, Koo S, Koh AL, Koh MJA. A novel NSDHL variant in CHILD syndrome with gastrointestinal manifestations and localized skin involvement. Mol Genet Genomic Med 2021; 10:e1848. [PMID: 34957706 PMCID: PMC8801147 DOI: 10.1002/mgg3.1848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/14/2021] [Indexed: 11/11/2022] Open
Abstract
Background CHILD syndrome is an X‐linked dominant disorder associated with pathogenic mutations in the NSDHL gene. The condition is predominantly found in females as it is lethal in males. Most cases present at birth with extensive unilateral ichthyosiform erythroderma involving the trunk and limbs. Milder and less extensive presentations have been reported, leading to misdiagnosis especially during early childhood. Methods and Results We report an adult female of Malay ancestry who presented with minimal skin and limb involvement. She was only diagnosed in adulthood when she presented with gastrointestinal symptoms and worsening of skin manifestations. The clinical diagnosis was suspected after a combination of clinical, pathological and immunohistochemistry correlation, and molecularly confirmed with the discovery of a frameshift variant in NSDHL. The novel variant was inherited from her mother who had some linear hypopigmented patches over the medial aspects of both her arms and right forearm. Conclusion We uncovered a novel frameshift variant associated with presentations that cast a new light on the clinical features of CHILD syndrome.
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Affiliation(s)
- Ene-Choo Tan
- Research Laboratory, KK Women's & Children's Hospital, Singapore, Singapore.,Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Shi Yun Chia
- Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore, Singapore.,Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Khadijah Rafi'ee
- Research Laboratory, KK Women's & Children's Hospital, Singapore, Singapore
| | - Shan Xian Lee
- Department of Dermatology, Changi General Hospital, Singapore, Singapore
| | - Andrew Boon Eu Kwek
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
| | - Sze Hwa Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore, Singapore
| | - Victor Weng Leong Ng
- Department of Laboratory Medicine, Changi General Hospital, Singapore, Singapore
| | - Heming Wei
- Research Laboratory, KK Women's & Children's Hospital, Singapore, Singapore
| | - Stephanie Koo
- Research Laboratory, KK Women's & Children's Hospital, Singapore, Singapore
| | - Ai Ling Koh
- Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore, Singapore.,Genetics Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mark Jean-Aan Koh
- Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore, Singapore.,Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
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Wong GHZ, Chia SY, Wei H, Rafi'ee K, Koh MJA, Tan EC. CARD14-associated papulosquamous eruption (CAPE) in a toddler responding to treatment with acitretin. Pediatr Dermatol 2021; 38:970-972. [PMID: 34075616 DOI: 10.1111/pde.14638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CARD14-associated papulosquamous eruption (CAPE) is a rare autosomal dominant dermatosis that presents classically in early childhood with clinical features of both psoriasis and pityriasis rubra pilaris (PRP). The disease is known to be refractory to topical and systemic therapies classically used for psoriasis, with the majority of reported cases requiring treatment with biologics, such as ustekinumab and secukinumab. We present a toddler with a clinical presentation consistent with CAPE and found to have a novel heterozygous variant of the CARD14 gene. She was refractory to treatment with topical emollients and topical corticosteroids, but responsive to oral acitretin.
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Affiliation(s)
| | - Shi Yun Chia
- Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore.,Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Heming Wei
- Research Laboratory, KK Women's & Children's Hospital, Singapore, Singapore
| | - Khadijah Rafi'ee
- Research Laboratory, KK Women's & Children's Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore.,Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Ene Choo Tan
- Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore, Singapore.,Research Laboratory, KK Women's & Children's Hospital, Singapore, Singapore
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Wei H, Wee LWY, Born B, Seang S, Koh MJA, Yee R, Lin G, Rafi'ee K, Mey S, Tan EC. Palmoplantar keratoderma, oral involvement, and homozygous CTSC mutation in two brothers from Cambodia. Am J Med Genet A 2019; 182:296-302. [PMID: 31846207 DOI: 10.1002/ajmg.a.61447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 12/28/2022]
Abstract
Haim-Munk syndrome (HMS) and Papillon-Lefevre syndrome (PLS) are phenotypic variants of palmoplantar keratoderma (PPK) with progressive early-onset periodontitis and dental caries. HMS and PLS have been associated with homozygous or compound heterozygous mutations in the lysosomal protease gene Cathepsin C (CTSC). There have been only a few documented cases of CTSC mutations in patients from South-East Asia. We report the clinical findings of two Cambodian brothers who presented with diffuse, demarcated PPK with transgrediens extending to the elbows and knees, as well as pachyonychia and dental caries. Arachnodactyly and periodontitis were also found in the older brother. Next-generation sequencing unveiled a homozygous missense variant in CTSC (NM_001814.5: c.1337AC: p.(Asp446Ala)) in both brothers. Both parents were heterozygous for the variant, while an unaffected older brother was homozygous for the wild-type allele. Our study adds to the spectrum of mutations and associated clinical presentations for this rare genodermatosis.
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Affiliation(s)
- Heming Wei
- Research Laboratory, KK Women's & Children's Hospital, Singapore
| | - Lynette W Y Wee
- Dermatology Service, KK Women's & Children's Hospital, Singapore
| | - Bori Born
- Department of Dermatology, Preah Kossamak Hospital, Phnom Penh, Cambodia
| | - Sokheng Seang
- Department of Dermatology, Preah Kossamak Hospital, Phnom Penh, Cambodia
| | - Mark J A Koh
- Dermatology Service, KK Women's & Children's Hospital, Singapore.,Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore
| | - Ruixiang Yee
- Dental Service, KK Women's & Children's Hospital, Singapore
| | - Grace Lin
- Research Laboratory, KK Women's & Children's Hospital, Singapore
| | - Khadijah Rafi'ee
- Research Laboratory, KK Women's & Children's Hospital, Singapore
| | - Sithach Mey
- Department of Dermatology, Preah Kossamak Hospital, Phnom Penh, Cambodia
| | - Ene-Choo Tan
- Research Laboratory, KK Women's & Children's Hospital, Singapore.,Paediatrics Academic Clinical Programme, SingHealth Duke-NUS Graduate Medical School, Singapore
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