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Luo C, Yang L, Huang Z, Su Y, Lu Y, Yu D, Zhang M, Wu K. Case report: A case of epidermolysis bullosa complicated with pyloric atresia and a literature review. Front Pediatr 2023; 11:1098273. [PMID: 37033187 PMCID: PMC10076629 DOI: 10.3389/fped.2023.1098273] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/09/2023] [Indexed: 04/11/2023] Open
Abstract
Objective This article aims to explore the diagnosis, molecular characteristics, treatment, and prognosis of epidermolysis bullosa with pyloric atresia (EB-PA). Methods The clinical manifestations, diagnosis and treatment, and genetic characteristics of a patient with EB-PA admitted to our hospital were analysed. The disease subtypes, concomitant abnormalities, molecular characteristics, and prognosis of patients with EB-PA were summarized by searching the EB-PA-related literature since 2011. Results We present a very low birth weight female infant with skin blisters and pyloric obstruction. Exome sequencing revealed heterozygous mutations in the ITGB4 gene: c.794dupC (p. S265fs*5) and c.2962G > A (p.A988T). This infant was diagnosed with EB-PA. Coverage of the wounds and Penicillin were used to prevent infection, but the patient eventually developed severe sepsis. A literature review was carried out including 49 cases of EB-PA; among these cases, 34 were preterm infants, weighing between 930 and 3,640 g. Of these EB-PA patients, 28 had accompanying malformations, including urinary system malformations and aplasia cutis congenita (ACC). Thirty-two patients identified the subtype of EB-PA, of whom 25 were diagnosed with junctional epidermolysis bullosa (JEB), 6 with epidermolysis bullosa simplex (EBS), and 1 with dystrophic epidermolysis bullosa (DEB). Genetic testing was conducted on 23 patients, of whom 15 carried Integrin Beta-4 (ITGB4) gene mutations and one JEB patient carried an Integrin Alpha-6 (ITGA6) gene mutation; 4 of the 5 EBS patients had Plectin (PLEC) gene mutations, and the other had an ITGB4 mutation. ITGB4 mutation cases involved 29 mutation sites, primarily concentrated in the region encoding the integrin beta subunit; PLEC mutation cases involved 7 mutation sites. Among all cases, 43 underwent pyloric atresia surgery, of whom 24 died postoperatively, and 6 without surgery therapy died within a short period. Conclusion EB-PA is a rare genetic disorder characterized by increased skin fragility and PA involving mutations in the ITGB4, PLEC, or ITGA6 genes. EB-PA has a high incidence of complications and mortality, surgery and supportive therapy are currently the most common treatment options.
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Affiliation(s)
| | | | | | | | | | | | | | - Kai Wu
- Department of Pediatric Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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2
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Kaneyasu H, Takahashi K, Ohta N, Okada S, Kimura S, Yasuno S, Murata S, Katsura S, Yamada N, Shiraishi K, Tsuda J, Miyai S, Kurahashi H, Hasegawa S, Shimomura Y. Novel compound heterozygous mutations in the PLEC gene in a neonate with epidermolysis bullosa simplex with pyloric atresia. J Dermatol 2023; 50:239-244. [PMID: 35996939 DOI: 10.1111/1346-8138.16553] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/06/2022] [Indexed: 02/04/2023]
Abstract
Epidermolysis bullosa (EB) is a heterogeneous group of inherited disorders characterized by the blistering of the skin and mucous membranes. Although the molecular basis of EB has been significantly elucidated, the precise phenotypes of the lethal types of EB have not been completely characterized. Herein, we report a severe case of EB with pyloric atresia (PA). The patient was a Japanese boy who not only had skin lesions but also various complications such as PA, dysphagia, hypotonia, infectious keratitis with corneal ulcer, obstructive uropathy and protein-losing enteropathy. Genetic analysis led to the identification of two novel compound heterozygous mutations in the last exon of the plectin (PLEC) gene. Based on this finding, EB simplex with PA was diagnosed. Immunostaining with anti-plectin antibodies revealed truncated plectin proteins lacking the C-terminus in the patient's skin. We also conducted a prenatal diagnosis in subsequent pregnancy. Our report further highlights the crucial role of plectin in many organs and provides valuable information regarding the phenotypes resulting from mutations in the PLEC gene.
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Affiliation(s)
- Hidenobu Kaneyasu
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kazumasa Takahashi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Naoki Ohta
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Seigo Okada
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Sasagu Kimura
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Shuichiro Yasuno
- Department of Dermatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Susumu Murata
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Shunsaku Katsura
- Division of Pediatric Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Naoyuki Yamada
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Koji Shiraishi
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Junko Tsuda
- Department of Otolaryngology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Shunsuke Miyai
- Division of Molecular Genetics, Institute for Comprehensive Medical Science Fujita Health University, Toyoake, Japan
| | - Hiroki Kurahashi
- Division of Molecular Genetics, Institute for Comprehensive Medical Science Fujita Health University, Toyoake, Japan
| | - Shunji Hasegawa
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yutaka Shimomura
- Department of Dermatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
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3
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Solanki S, Menon P, Dogra S, Samujh R. Duodenal and Pyloric Web in Children: Clinical Presentation and Management. J Indian Assoc Pediatr Surg 2022; 27:125-130. [PMID: 35937123 PMCID: PMC9350632 DOI: 10.4103/jiaps.jiaps_339_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/11/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Duodenal and pyloric web (DW/PW) can present at any age, symptoms depend upon the location of the web along with the presence and size of the opening in the web. The surgical management is not straightforward always. Here, in this study, we aim to assess clinical characteristics, management, and outcome of children with DW/PW. MATERIALS AND METHODOLOGY This was a retrospective study from 2005 to 2019, and data were collected from record registers. All children of DW/PW presented between this duration were included in this study. RESULTS A total of 45 patients (age range = 1 day to 11 years) included in the study, 40 had DW while 5 had PW. Seven patients were diagnosed antenatally and 20 patients had associated congenital anomalies. Most patients presented with vomiting either bilious or nonbilious. Plain X-ray was sufficient for the diagnosis in 60% of patients, the rest diagnosed on contrast study. The web excision and pyloroplasty were done for PW. The web excision and Heineke-Mikulicz type enteroplasty was the preferred surgery for DW but some patients were required Kimura's duodeno-duodenostomy. For postoperative nutrition, enteral feeding was established through the placement of a feeding tube beyond anastomosis. Ten patients died due to septicemia and associated anomalies. Four patients had a minor leak which was managed by conservative means. Four patients required redo surgery, adhesive obstruction was the most common indication. During follow-up, all 35 patients were doing well with no major complaints. CONCLUSION DW/PW has different presentations as compared to other intestinal atresia and can present at any age. A contrast study confirms the diagnosis when plain X-ray is inconclusive. Associated anomalies and septicemia are the poor prognostic indicators. Postoperative enteral feeding helps in maintaining adequate nutrition and improves the outcome even in children with a minor anastomotic leak.
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Affiliation(s)
| | - Prema Menon
- Department of Pediatric Surgery, PGIMER, Chandigarh, India,Address for correspondence: Dr. Prema Menon, Block 3A, Room no. 3103, Advanced Pediatric Centre, Sector 12, Chandigarh- 160 012, India. E-mail:
| | - Shivani Dogra
- Department of Pediatric Surgery, PGIMER, Chandigarh, India
| | - Ram Samujh
- Department of Pediatric Surgery, PGIMER, Chandigarh, India
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4
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Prasad GR, Rao JVS, Fatima F, Anjum F. Congenital Pyloric Atresia: Experience with a Series of 11 Cases and Collective Review. J Indian Assoc Pediatr Surg 2021; 26:416-420. [PMID: 34912139 PMCID: PMC8637985 DOI: 10.4103/jiaps.jiaps_295_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/20/2020] [Accepted: 11/27/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction: Pyloric atresia is a rare cause of congenital gastric outlet obstruction. It is often associated with epidermolysis bullosa (EB). Rarity and experience with 11 cases are the reason for this publication. Aims and Objectives: The aim and objective of this study is to present our experience of 11 cases of congenital pyloric atresia and correlate with available literature. Materials and Methods: This was retrospective cohort of 11 cases correlative comparative study. Data of all the 11 cases from 1982 to 2019 were collected, reviewed, and analyzed. The parameters studied included age, gender, antenatal diagnosis, postnatal diagnosis, preoperative management, intraoperative findings, postoperative course outcome, associated anomalies, and any genetic studies if done. All these parameters were compared with published data. Results: There were 11 cases in the present series with six boys and five girls. Most of them presented at varying periods from birth to day 1 of life. Discussion: Congenital pyloric atresia may be isolated or associated with EB. Three varieties of pyloric atresia were described. Association with EB increases the mortality. Conclusions: Review and analysis of 11 cases of pyloric atresia compared with published literature is being reported.
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Affiliation(s)
| | - J V Subba Rao
- Department of Anesthesia, DCMS, Hyderabad, Telangana, India
| | - Firdous Fatima
- Department of General Surgery, DCMS, Hyderabad, Telangana, India
| | - Fariha Anjum
- Department of General Surgery, DCMS, Hyderabad, Telangana, India
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5
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Kozlov Y, Poloyan S, Kapuller V. Laparoscopic Treatment of Type I of Pyloric Atresia: Case Report. J Laparoendosc Adv Surg Tech A 2021; 31:1507-1510. [PMID: 34846943 DOI: 10.1089/lap.2021.0254] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Pyloric atresia is one of the rarest surgical diseases in newborns. Laparotomy is the most common approach to correct this abnormality. In the modern scientific literature, there is only one report on the endosurgical treatment of pyloric atresia. The case of laparoscopic correction of gastric outlet atresia presented in this study is another reference to the successful treatment of this condition. Methods: The clinical case is presented by a newborn boy in whom a prenatal ultrasound (US) examination at 31 weeks of gestation revealed polyhydramnios and an enlarged stomach. The baby was born on 37th week of gestation, his birth weight was 2660 g. In the 1st hours of life, the child showed symptoms of high intestinal obstruction in the form of vomiting of gastric contents. Postnatal US and X-ray examination established the diagnosis of pyloric atresia. During laparoscopy, performed on the 2nd day of life, the morphological type of anomaly was assessed and type I atresia, represented by a membrane, was established. A laparoscopic membranectomy with Heineke-Mikulicz pyloroplasty was performed. The early and late results of the operation were investigated. Results: The duration of the operation was 70 minutes. The postoperative period was uneventful. Enteral nutrition was started on the postoperative day (POD) 3. A complete enteral diet became possible on day 7. The newborn was discharged from the hospital on the POD 9. Histological examination confirmed the diagnosis of membranous type of pyloric atresia. During follow-up for 12 months, no complications associated with the surgical procedure were found. Conclusion: Description of the case of laparoscopic treatment of type I pyloric atresia in a newborn expands the use of laparoscopy in pediatric practice.
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Affiliation(s)
- Yury Kozlov
- Department of Pediatric Surgery, Irkutsk Regional Pediatric Clinical Hospital, Irkutsk, Russia.,Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia.,Irkutsk State Medical University Russia, Irkutsk, Russia
| | - Simon Poloyan
- Department of Pediatric Surgery, Irkutsk Regional Pediatric Clinical Hospital, Irkutsk, Russia
| | - Vadim Kapuller
- Department of Pediatric Surgery, Faculty of Health Sciences, Assuta University Medical Center, Ben Gurion University of the Negev, Ashdod, Israel
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6
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Abstract
Plectin is a multi-faceted, 500 kDa-large protein, which due to its expression in different isoforms and distinct organs acts diversely as a cytoskeletal crosslinker and signaling scaffold. It functions as a mediator of keratinocyte mechanical stability in the skin, primarily through linking intermediate filaments to hemidesmosomes. Skin fragility may occur through the presence of mutations in the gene encoding for plectin, PLEC, or through the presence of autoantibodies against the molecule. Below, we review the cutaneous manifestations of plectinopathies as well as their systemic involvement in specific disease subtypes. We summarize the known roles of plectin in keratinocytes and fibroblasts and provide an outlook on future perspectives for plectin-associated skin disorders.
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Affiliation(s)
- Dimitra Kiritsi
- Department of Dermatology, Faculty of Medicine, Medical Center-University of Freiburg, 79104 Freiburg, Germany;
- Correspondence:
| | | | - Franziska Schauer
- Department of Dermatology, Faculty of Medicine, Medical Center-University of Freiburg, 79104 Freiburg, Germany;
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7
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Zhou X, Wang M, Wang S, Jiang X, Li W. Identification of novel compound heterozygous ITGB4 mutations in a Chinese woman with junctional epidermolysis bullosa without pylori atresia but profound urinary symptoms: A case report and review of the literature. J Dermatol 2021; 48:1780-1785. [PMID: 34462954 DOI: 10.1111/1346-8138.16104] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 02/05/2023]
Abstract
Loss of α6 and β4 integrin expression caused by germ line mutations in ITGA6 and ITGB4 usually leads to junctional epidermolysis bullosa (JEB) with pyloric atresia (PA) (JEB-PA; Online Mendelian Inheritance in Man #226730). However, recent studies have suggested that integrin-associated JEB may occur without PA but with other symptoms of the epithelial tissues. Here, we present a case of a Chinese woman with JEB without PA but with profound urinary symptoms. Mutation analysis revealed that the patient carried compound heterozygous mutations in the ITGB4 gene: a frameshift mutation c.600dupC (p.Phe201Leufs*15) and a novel missense mutation c.599C>G (p.Pro200Arg). Our report not only raises the question of whether the designation JEB-PA is appropriate, but also expands our current knowledge of the ITGB4 mutation spectrum.
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Affiliation(s)
- Xingli Zhou
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China.,Department of Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
| | - Mi Wang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Sheng Wang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China.,Department of Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, China
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8
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Soyer T, Karaosmanoglu B, Taskiran EZ, Kiper PÖŞ, Karnak İ, Boduroğlu K, Utine GE. Biallelic ITGB4 variants in familial pyloric atresia without epidermolysis bullosa: Report of two families with five siblings. Am J Med Genet A 2021; 185:3427-3432. [PMID: 34403180 DOI: 10.1002/ajmg.a.62462] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/28/2021] [Accepted: 08/06/2021] [Indexed: 11/11/2022]
Abstract
Pyloric atresia (PA) is a rare gastrointestinal anomaly that occurs either as an isolated lesion or in association with other congenital or hereditary anomalies. Familial occurrence of PA with epidermolysis bullosa (EB) has been well documented and variants in ITGA6, ITGB4, and PLEC are known to cause EB with PA. However, no gene variants have been defined in familial isolated PA. Five siblings with familial isolated PA are presented that suggest biallelic ITGB4 variants may underlie the development of PA without EB. Five siblings from two unrelated families with isolated PA were studied with exome sequencing (ES) to identify the genetic etiology in isolated familial cases. Exome sequencing was performed in one affected patient from each family. Validation and segregation studies were done by Sanger sequencing. Parents were first cousins in one family but there was no consanguinity in the other family. Type-2 PA was detected in both families and none of the probands had associated anomalies. All patients underwent successful gastroduodenostomy and have been under follow-up uneventfully. All patients had biallelic ITGB4 variants, c.2032G > T p.(Asp678Tyr) being a novel one. Biallelic ITGB4 variants may underlie the development of PA without associated EB. Further detection of variants in this gene may establish any possible genotype-phenotype correlations.
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Affiliation(s)
- Tutku Soyer
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Beren Karaosmanoglu
- Department of Medical Genetics, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ekim Z Taskiran
- Department of Medical Genetics, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | | | - İbrahim Karnak
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Koray Boduroğlu
- Department of Pediatric Genetics, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Gülen Eda Utine
- Department of Pediatric Genetics, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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9
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Pan P. Congenital Pyloric Atresia and Epidermolysis Bullosa: Report of a Rare Association. J Indian Assoc Pediatr Surg 2021; 26:256-258. [PMID: 34385771 PMCID: PMC8323568 DOI: 10.4103/jiaps.jiaps_125_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/19/2020] [Accepted: 01/24/2021] [Indexed: 11/20/2022] Open
Abstract
Pyloric atresia (PA) is an unusual congenital disorder that accounts for about 1% of all intestinal atresia, with an incidence around 1 in 100,000 live births. PA may occur as an isolated disorder or may be associated with epidermolysis bullosa (EB). EB comprises a heterogeneous group of cutaneous genetic diseases of inherited blistering and skin fragility disorders. Wound management in EB is complex and influenced by several comorbidities and the fragility of the skin. The prognosis of children with EB depends on the type of mutation inherited. Some types are mild and even improve with age, while others are so severe it is not likely that a child to survive into adulthood. We present three cases of PA in this article and one in conjunction with junctional EB.
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Affiliation(s)
- Pradyumna Pan
- Pediatric Surgery Unit, Ashish Hospital and Research Centre, Jabalpur, Madhya Pradesh, India
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10
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Matyas M, Miclea D, Zaharie G. Case Report: Uncommon Association of ITGB4 and KRT10 Gene Mutation in a Case of Epidermolysis Bullosa With Pyloric Atresia and Aplasia Cutis Congenita. Front Genet 2021; 12:641977. [PMID: 34306001 PMCID: PMC8296908 DOI: 10.3389/fgene.2021.641977] [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: 02/16/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Epidermolysis bullosa is a rare form of genodermatosis produced by different gene mutations. The junctional form of the disease (JEB-PA) can associate pyloric atresia, renal abnormalities, and aplasia cutis congenita. Case Description: A case of a male preterm newborn with suspicion of digestive tube malformation at fetal ultrasound and who was born by cesarian section. At birth, he presented extensive cutaneous aplasia on the lower limbs and bilaterally under ears; outer ear agenesis; nasal septum hypoplasia; micrognathia; multiple blisters on the face, trunk, and limbs; lower limb deformities and absence of toe nails. Pathological examination following a surgical procedure with unfavorable outcome showed pyloric atresia, junctional form of epidermolysis bullosa and aplasia cutis congenita. Homozygous variants in two genes were identified: c.3111+1G>A in ITGB4 (class 5) and c.1498G>T in KRT10 (class 3). Conclusion: The particularity of our case is the novel finding of a coincidental occurrence in the context of consaguinity of two mutations in the ITGB4 and KRT10 genes, and clinical characteristics of epidermolysis bullosa.
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Affiliation(s)
- Melinda Matyas
- Neonatology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Diana Miclea
- Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gabriela Zaharie
- Neonatology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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11
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Al Faqeeh AA, Syed MK, Hussain S, Almas T, Ammar M. Carmi Syndrome in a Neonate: An Exacting Surgical Challenge. Cureus 2020; 12:e10522. [PMID: 33094063 PMCID: PMC7574818 DOI: 10.7759/cureus.10522] [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] [Indexed: 11/05/2022] Open
Abstract
Carmi syndrome is characterized by the concomitant presence of pyloric atresia and epidermolysis bullosa. Pyloric atresia routinely presents with symptoms of gastrointestinal obstruction, which include vomiting and feeding intolerance. On the other hand, epidermolysis bullosa presents with blistering skin lesions upon the slightest trauma. Due to these skin lesions, the affected patients are particularly susceptible to developing septicemia and adverse disease outcomes. We hereby delineate a case of Carmi syndrome in a neonate who was treated surgically. Postoperatively, the neonate began to deteriorate and eventually developed septicemia and passed away shortly thereafter.
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Affiliation(s)
| | | | - Salman Hussain
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Talal Almas
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
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12
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Ko L, Griggs CL, Mylonas KS, Masiakos PT, Kroshinsky D. A Nonlethal Case of Junctional Epidermolysis Bullosa and Congenital Pyloric Atresia: Compound Heterozygosity in a Patient with a Novel Integrin Beta 4 Gene Mutation. J Pediatr 2018; 193:261-264.e1. [PMID: 29198538 DOI: 10.1016/j.jpeds.2017.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Received: 06/30/2017] [Revised: 09/12/2017] [Accepted: 09/14/2017] [Indexed: 12/16/2022]
Abstract
We report a case of nonfatal junctional epidermolysis bullosa and pyloric atresia in a newborn. We identified a substitution (c.914C>T) for the integrin β4 gene that has been associated with favorable outcome. A novel mutation (c.2011T>G) of unknown significance was also found in this patient who is now thriving.
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Affiliation(s)
- Lauren Ko
- Harvard Medical School, Boston, MA; Department of Dermatology, Massachusetts General Hospital, Boston, MA
| | - Cornelia L Griggs
- Harvard Medical School, Boston, MA; Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Konstantinos S Mylonas
- Harvard Medical School, Boston, MA; Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA.
| | - Peter T Masiakos
- Harvard Medical School, Boston, MA; Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA
| | - Daniela Kroshinsky
- Harvard Medical School, Boston, MA; Department of Dermatology, Massachusetts General Hospital, Boston, MA
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13
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Kayki G, Bozkaya D, Ozaltin F, Orhan D, Kaymaz F, Korkmaz E, Yigit S. Epidermolysis Bullosa with Pyloric Atresia and Aplasia Cutis in a Newborn Due to Homozygous Mutation in ITGB4. Fetal Pediatr Pathol 2017; 36:332-339. [PMID: 28557647 DOI: 10.1080/15513815.2017.1324545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 10/19/2022]
Abstract
BACKGROUND Epidermolysis bullosa with pyloric atresia (EB-PA) is an autosomal recessive disorder due to mutations in ITGA6 and/or ITGB4, resulting in altered expression of α6β4 integrin. EB-PA can also occur with aplasia cutis. CASE REPORT We present a newborn with EB-PA and aplasia cutis, born of consanguineous parents, with a homozygous c.3793+1G>A mutation affecting ITGB4, previously described only in the heterozygous state with other mutations. CONCLUSION The previously unreported homozygous c.3793+1G>A mutation affecting ITGB4 causes a severe form of junctional epidermolysis bullosa with pyloric atresia and aplasia cutis.
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Affiliation(s)
- Gozdem Kayki
- a Department of Pediatrics , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Davut Bozkaya
- b Division of Neonatology, Department of Pediatrics , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Fatih Ozaltin
- c Department of Pediatric Nephrology, Nephrogenetics Laboratory, Center for Biobanking and Genomics , Hacettepe University , Ankara , Turkey
| | - Diclehan Orhan
- c Department of Pediatric Nephrology, Nephrogenetics Laboratory, Center for Biobanking and Genomics , Hacettepe University , Ankara , Turkey
| | - Figen Kaymaz
- d Department of Histology , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Emine Korkmaz
- e Nephrogenetics Laboratory , Hacettepe University Faculty of Medicine , Sihhiye, Ankara , Turkey
| | - Sule Yigit
- b Division of Neonatology, Department of Pediatrics , Hacettepe University Faculty of Medicine , Ankara , Turkey
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14
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Abstract
Bowel obstruction is a common cause for admission into the NICU, but pyloric atresia (PA) is a very rare cause of bowel obstruction. This article illustrates the development of the fetal gastrointestinal tract, most specifically the stomach and pylorus. Pathophysiology, typing, and treatment of PA are also explored. Presented are two cases of PA that occurred in a Level III NICU one month apart. Management of this condition is surgical in nature. Long-term prognosis is usually excellent because this defect is often isolated.
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Mencía Á, García M, García E, Llames S, Charlesworth A, de Lucas R, Vicente A, Trujillo-Tiebas MJ, Coto P, Costa M, Vera Á, López-Pestaña A, Murillas R, Meneguzzi G, Jorcano JL, Conti CJ, Escámez Toledano MJ, del Río Nechaevsky M. Identification of two rare and novel large deletions in ITGB4 gene causing epidermolysis bullosa with pyloric atresia. Exp Dermatol 2016; 25:269-74. [PMID: 26739954 DOI: 10.1111/exd.12938] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2015] [Indexed: 12/21/2022]
Abstract
Epidermolysis bullosa with pyloric atresia (EB-PA) is a rare autosomal recessive hereditary disease with a variable prognosis from lethal to very mild. EB-PA is classified into Simplex form (EBS-PA: OMIM #612138) and Junctional form (JEB-PA: OMIM #226730), and it is caused by mutations in ITGA6, ITGB4 and PLEC genes. We report the analysis of six patients with EB-PA, including two dizygotic twins. Skin immunofluorescence epitope mapping was performed followed by PCR and direct sequencing of the ITGB4 gene. Two of the patients presented with non-lethal EB-PA associated with missense ITGB4 gene mutations. For the other four, early postnatal demise was associated with complete lack of β4 integrin due to a variety of ITGB4 novel mutations (2 large deletions, 1 splice-site mutation and 3 missense mutations). One of the deletions spanned 278 bp, being one of the largest reported to date for this gene. Remarkably, we also found for the first time a founder effect for one novel mutation in the ITGB4 gene. We have identified 6 novel mutations in the ITGB4 gene to be added to the mutation database. Our results reveal genotype-phenotype correlations that contribute to the molecular understanding of this heterogeneous disease, a pivotal issue for prognosis and for the development of novel evidence-based therapeutic options for EB management.
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Affiliation(s)
- Ángeles Mencía
- Department of Bioengineering, Tissue Engineering and Regenerative Medicine Group (TERMeG), Universidad Carlos III de Madrid, Madrid, Spain.,Regenerative Medicine Unit, Centro de Investigaciones Energética Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain.,Instituto de Investigación Sanitaria de la Fundación Jimenez Diaz (IIS-FJD), Madrid, Spain
| | - Marta García
- Department of Bioengineering, Tissue Engineering and Regenerative Medicine Group (TERMeG), Universidad Carlos III de Madrid, Madrid, Spain.,Regenerative Medicine Unit, Centro de Investigaciones Energética Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain.,Instituto de Investigación Sanitaria de la Fundación Jimenez Diaz (IIS-FJD), Madrid, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
| | - Eva García
- Instituto de Investigación Sanitaria de la Fundación Jimenez Diaz (IIS-FJD), Madrid, Spain.,Laboratorio de Ingeniería de Tejidos, Centro Comunitario de Sangre y Tejidos de Asturias (CCST) Asturias, Oviedo, Spain
| | - Sara Llames
- Instituto de Investigación Sanitaria de la Fundación Jimenez Diaz (IIS-FJD), Madrid, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain.,Laboratorio de Ingeniería de Tejidos, Centro Comunitario de Sangre y Tejidos de Asturias (CCST) Asturias, Oviedo, Spain
| | - Alexandra Charlesworth
- French Reference Centre for Inherited Epidermolysis Bullosa, L'Archet Hospital, BP 3079, 06202, Nice, Cedex3, France
| | - Raúl de Lucas
- Sección de Dermatología, Hospital Universitario La Paz, Madrid, Spain
| | - Asunción Vicente
- Servicio de Dermatología, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - María José Trujillo-Tiebas
- Instituto de Investigación Sanitaria de la Fundación Jimenez Diaz (IIS-FJD), Madrid, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain.,Instituto de Investigación Sanitaria de la Fundación Jimenez Diaz (IIS-FJD), Hospital Universitario Jiménez Díaz, Madrid, Spain
| | - Pablo Coto
- Servicio de Dermatología y Neonatología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Marta Costa
- Servicio de Dermatología y Neonatología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ángel Vera
- Servicio de Dermatología, Complejo Hospitalario Carlos Haya, Málaga, Spain
| | | | - Rodolfo Murillas
- Regenerative Medicine Unit, Centro de Investigaciones Energética Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain.,Instituto de Investigación Sanitaria de la Fundación Jimenez Diaz (IIS-FJD), Madrid, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
| | - Guerrino Meneguzzi
- INSERM U1081, CNRS UMR7284, University of Nice, Sophia Antipolis, Faculty of Medicine, 28 Avenue Valombrose, F-06107, Nice, France
| | - José Luis Jorcano
- Department of Bioengineering, Tissue Engineering and Regenerative Medicine Group (TERMeG), Universidad Carlos III de Madrid, Madrid, Spain.,Regenerative Medicine Unit, Centro de Investigaciones Energética Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain
| | - Claudio J Conti
- Department of Bioengineering, Tissue Engineering and Regenerative Medicine Group (TERMeG), Universidad Carlos III de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria de la Fundación Jimenez Diaz (IIS-FJD), Madrid, Spain
| | - María José Escámez Toledano
- Department of Bioengineering, Tissue Engineering and Regenerative Medicine Group (TERMeG), Universidad Carlos III de Madrid, Madrid, Spain.,Regenerative Medicine Unit, Centro de Investigaciones Energética Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain.,Instituto de Investigación Sanitaria de la Fundación Jimenez Diaz (IIS-FJD), Madrid, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
| | - Marcela del Río Nechaevsky
- Department of Bioengineering, Tissue Engineering and Regenerative Medicine Group (TERMeG), Universidad Carlos III de Madrid, Madrid, Spain.,Regenerative Medicine Unit, Centro de Investigaciones Energética Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain.,Instituto de Investigación Sanitaria de la Fundación Jimenez Diaz (IIS-FJD), Madrid, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
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Chahed J, Mekki M, Ksia A, Kechiche N, Hidouri S, Youssef TM, Sahnoun L, Krichene I, Belghith M, Nouri A. Management of digestive lesions associated to congenital epidermolysis bullosa. Afr J Paediatr Surg 2015; 12:221-6. [PMID: 26712284 PMCID: PMC4955475 DOI: 10.4103/0189-6725.172544] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Congenital epidermolysis bullosa (CEB) is a rare genodermatosis. The digestive system is very frequently associated with skin manifestations. Pyloric atresia (PA) and oesophageal stenosis (OS) are considered the most serious digestive lesions to occur.The aim of this work is to study the management and the outcome of digestive lesions associated to CEB in four children and to compare our results to the literature. PATIENTS AND METHODS A retrospective study of four observations: Two cases of PA and two cases of OS associated to CEB managed in the Paediatric Surgery Department of Fattouma Bourguiba Teaching Hospital in Monastir, Tunisia. RESULTS Four patients, two of them are 11 and 8 years old, diagnosed as having a dystrophic epidermolysis bullosa since the neonatal period. They were admitted for the investigation of progressive dysphagia. Oesophageal stenosis was confirmed by an upper contrast study. Pneumatic dilation was the advocated therapeutic method for both patients with a favourable outcome. The two other patients are newborns, diagnosed to have a CEB because of association of PA with bullous skin lesions with erosive scars. Both patients had a complete diaphragm excision with pyloroplasty. They died at the age of 4 and 3 months of severe diarrhoea resistant to medical treatment. CONCLUSION Digestive lesions associated to CEB represent an aggravating factor of a serious disease. OS complicating CEB is severe with difficult management. Pneumatic dilatation is the gold standard treatment method. However, the mortality rate in PA with CEB is high. Prenatal diagnosis of PA is possible, and it can help avoiding lethal forms.
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Affiliation(s)
- Jamila Chahed
- Department of Paediatric Surgery, School of Medicine of Monastir, University of Monastir, Monastir, Tunisia
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