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Clinical report of 8 patients with 49,XXXXY syndrome: Delineation of the facial gestalt and depiction of the clinical spectrum. Eur J Med Genet 2018; 62:210-216. [PMID: 30031153 DOI: 10.1016/j.ejmg.2018.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/07/2018] [Accepted: 07/17/2018] [Indexed: 12/26/2022]
Abstract
49,XXXXY syndrome is a rare sex chromosome aneuploidy syndrome. Cognitive impairment with expressive language deficits in combination with developmental and speech dyspraxia are cardinal symptoms. Testicular insufficiency becomes apparent during adolescence. Neurological, musculoskeletal, genital, orthodontic and immunological anomalies are common and a higher incidence of congenital malformations has been described. Here we show the evolving clinical and facial phenotype of eight boys and men with 49,XXXXY, demonstrating an increasingly perceptible distinct facial gestalt over time. In addition, almost all patients had muscular hypotonia, radioulnar synostosis, white matter anomalies, fifth-finger clinodactyly, recurrent respiratory infections in early childhood and teeth anomalies. IQ scores ranged between 40 and 70. Though many boys showed short stature at some point in early childhood, most outgrew it. As more long term data of boys and men with 49,XXXXY become available, parents of affected boys can be counseled more specifically as to the expected course and spectrum of this rare chromosomal disorder. Moreover, the multidisciplinary support can be optimized und unnecessary diagnostics avoided.
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Schatorjé E, van der Flier M, Seppänen M, Browning M, Morsheimer M, Henriet S, Neves JF, Vinh DC, Alsina L, Grumach A, Soler-Palacin P, Boyce T, Celmeli F, Goudouris E, Hayman G, Herriot R, Förster-Waldl E, Seidel M, Simons A, de Vries E. Primary immunodeficiency associated with chromosomal aberration - an ESID survey. Orphanet J Rare Dis 2016; 11:110. [PMID: 27484815 PMCID: PMC4971718 DOI: 10.1186/s13023-016-0492-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/27/2016] [Indexed: 11/21/2022] Open
Abstract
Background Patients with syndromic features frequently suffer from recurrent respiratory infections, but little is known about the spectrum of immunological abnormalities associated with their underlying chromosomal aberrations outside the well-known examples of Down and DiGeorge syndromes. Therefore, we performed this retrospective, observational survey study. Methods All members of the European Society for Immunodeficiencies (ESID) were invited to participate by reporting their patients with chromosomal aberration (excluding Down and DiGeorge syndromes) in combination with one or more identified immunological abnormalities potentially relating to primary immunodeficiency. An online questionnaire was used to collect the patient data. Results Forty-six patients were included from 16 centers (24 males, 22 females; median age 10.4 years [range 1.0–69.2 years]; 36 pediatric, 10 adult patients). A variety of chromosomal aberrations associated with immunological abnormalities potentially relating to primary immune deficiency was reported. The most important clinical presentation prompting the immunological evaluation was ‘recurrent ear-nose-throat (ENT) and airway infections’. Immunoglobulin isotype and/or IgG-subclass deficiencies were the most prevalent immunological abnormalities reported. Conclusions Our survey yielded a wide variety of chromosomal aberrations associated with immunological abnormalities potentially relating to primary immunodeficiency. Although respiratory tract infections can often also be ascribed to other causes (e.g. aspiration or structural abnormalities), we show that a significant proportion of patients also have an antibody deficiency requiring specific treatment (e.g. immunoglobulin replacement, antibiotic prophylaxis). Therefore, it is important to perform immunological investigations in patients with chromosomal aberrations and recurrent ENT or airway infections, to identify potential immunodeficiency that can be specifically treated. Electronic supplementary material The online version of this article (doi:10.1186/s13023-016-0492-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ellen Schatorjé
- Department Pediatrics, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME, 's-Hertogenbosch, The Netherlands
| | - Michiel van der Flier
- Department of Pediatrics, Amalia Children's Hospital and Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Mikko Seppänen
- Immunodeficiency Unit, Inflammation Center and Center for Rare Diseases, Children's Hospital, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Stefanie Henriet
- Department of Pediatrics, Amalia Children's Hospital and Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, The Netherlands
| | - João Farela Neves
- Primary Immunodeficiencies unit Hospital Dona Estefania, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | | | - Laia Alsina
- Allergy and Clinical Immunology Department, Hospital Sant Joan de Deu, Barcelona, Spain
| | | | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Fatih Celmeli
- Antalya Education and Research Hospital Department of Pediatric Immunology and Allergy, Antalya, Turkey
| | | | - Grant Hayman
- Epsom & St Helier University Hospitals NHS Trust, Carshalton, UK
| | | | - Elisabeth Förster-Waldl
- Department of Pediatrics and Adolescent Medicine, Center for Congenital Immunodeficiencies, Medical University Vienna, Wien, Austria
| | - Markus Seidel
- Pediatric Hematology-Oncology, Medical University Graz, Graz, Austria
| | - Annet Simons
- Department of Human Genetics, Radboudumc, Nijmegen, The Netherlands
| | - Esther de Vries
- Department Pediatrics, Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME, 's-Hertogenbosch, The Netherlands. .,Department Tranzo, Tilburg University, Tilburg, The Netherlands.
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Mazzilli R, Delfino M, Elia J, Benedetti F, Alesi L, Chessa L, Mazzilli F. Testosterone replacement in 49,XXXXY syndrome: andrological, metabolic and neurological aspects. Endocrinol Diabetes Metab Case Rep 2015; 2016:150114. [PMID: 26767114 PMCID: PMC4709582 DOI: 10.1530/edm-15-0114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 12/23/2015] [Indexed: 11/20/2022] Open
Abstract
We report the case of a 19-year-old boy, presenting several congenital malformations (facial dysmorphisms, cardiac and musculoskeletal abnormalities), mental retardation, recurrent respiratory infections during growth and delayed puberty. Although previously hospitalised in other medical centres, only psychological support had been recommended for this patient. In our department, genetic, biochemical/hormonal and ultrasound examinations were undertaken. The karyotype was 49,XXXXY, a rare aneuploidy with an incidence of 1/85 000–100 000, characterised by the presence of three extra X chromosomes in phenotypically male subjects. The hormonal/biochemical profile showed hypergonadotropic hypogonadism, insulin resistance and vitamin D deficiency. The patient was then treated with testosterone replacement therapy. After 12 months of treatment, we observed the normalisation of testosterone levels. There was also an increase in pubic hair growth, testicular volume and penis size, weight loss, homeostatic model assessment index reduction and the normalisation of vitamin D values. Moreover, the patient showed greater interaction with the social environment and context.
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Affiliation(s)
- Rossella Mazzilli
- Andrology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University of Rome "Sapienza" , Via di Grottarossa 103500189, Rome , Italy
| | - Michele Delfino
- Andrology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University of Rome "Sapienza" , Via di Grottarossa 103500189, Rome , Italy
| | - Jlenia Elia
- Andrology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University of Rome "Sapienza" , Via di Grottarossa 103500189, Rome , Italy
| | - Francesco Benedetti
- Andrology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University of Rome "Sapienza" , Via di Grottarossa 103500189, Rome , Italy
| | - Laura Alesi
- Genetics Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University of Rome "Sapienza" , Via di Grottarossa 103500189, Rome , Italy
| | - Luciana Chessa
- Genetics Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University of Rome "Sapienza" , Via di Grottarossa 103500189, Rome , Italy
| | - Fernando Mazzilli
- Andrology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University of Rome "Sapienza" , Via di Grottarossa 103500189, Rome , Italy
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Slae M, Heshin-Bekenstein M, Simckes A, Heimer G, Engelhard D, Eisenstein EM. Female polysomy-X and systemic lupus erythematosus. Semin Arthritis Rheum 2013; 43:508-12. [PMID: 24012046 DOI: 10.1016/j.semarthrit.2013.07.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 07/17/2013] [Accepted: 07/30/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Systemic lupus erythematosus (SLE) occurs more commonly in females than in males. Recent evidence suggests that genetic factors transmitted by the X-chromosome may confer increased risk for autoimmune disease in general, and for SLE in particular. It is therefore possible that X-chromosome polysomy might confer further increased risk for lupus. In addition to describing the clinical and immunologic features of a young woman with polysomy-X and SLE, we sought to review all other published cases associating female or male polysomy-X with SLE or other forms of autoimmunity. METHODS We report a case of a prepubertal girl with polysomy-X and SLE. We performed a systemic literature review for cases of polysomy-X and SLE and summarize previously published cases. In addition, we reviewed reports concerning the possible association between SLE and other connective tissue diseases and male polysomy-X. RESULTS An 11-year-old girl with tetrasomy-X (48 XXXX karyotype) presented with prolonged fever. Workup led to the diagnosis of SLE, and subsequent renal biopsy revealed mild diffuse mesangial proliferative glomerulonephritis. Two additional cases of SLE in women with 47 XXX and one of 48 XXXX karyotype were found in a literature review and compared to the present case. We identified studies that found X-chromosome polysomy to be over-represented in male patients with SLE and case descriptions of connective tissue diseases occurring in patients with polysomy-X. CONCLUSION No consistent pattern of disease was observed in female polysomy patients with SLE. Taken together with the data concerning the frequency of polysomy-X among males with SLE, our findings provide additional support for the hypothesis that X-chromosome polysomy may confer increased susceptibility to SLE. Molecular mechanisms that might account for this phenomenon are discussed.
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Affiliation(s)
- Mordechai Slae
- Department of Pediatrics, University of Alberta Hospital, Edmonton, Alberta, Canada.
| | - Merav Heshin-Bekenstein
- Department of Pediatrics, Hadassah-Hebrew University Hospital at Ein Kerem, Jerusalem, Israel
| | - Ari Simckes
- Department of Pediatrics, Hadassah-Hebrew University Hospital at Ein Kerem, Jerusalem, Israel
| | - Gali Heimer
- Department of Pediatrics, Hadassah-Hebrew University Hospital at Ein Kerem, Jerusalem, Israel
| | - Dan Engelhard
- Department of Pediatrics, Hadassah-Hebrew University Hospital at Ein Kerem, Jerusalem, Israel
| | - Eli M Eisenstein
- Department of Pediatrics, Hadassah-Hebrew University Hospital at Mount-Scopus, Jerusalem, Israel
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