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Chromosomal abnormalities related to fever of unknown origin in a Chinese pediatric cohort and literature review. Orphanet J Rare Dis 2022; 17:292. [PMID: 35897075 PMCID: PMC9327306 DOI: 10.1186/s13023-022-02444-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fever of unknown origin (FUO) has been difficult to diagnose in pediatric clinical practice. With the gradual change in the disease spectrum, genetic factors have received increasing attention. Limited studies have shown an association between FUO and chromosomal abnormalities. In this study, we investigated the clinical and genetic characteristics of patients with FUO presenting with chromosomal abnormalities in a Chinese pediatric cohort. RESULTS Chromosomal abnormalities were detected in 5.5% (8/145) of the patients with FUO. Six patients with inflammatory fever presented with pharyngitis/amygdalitis (4/6), oral aphthous ulcer (2/6), digestive symptoms (3/6), developmental delay (4/6) and elevated C-reactive protein levels (6/6) during fever. These patients were often considered to have systemic inflammatory diseases, such as Behcet's disease or systemic juvenile idiopathic arthritis. Trisomy 8, 7q11.23 dup, 3p26.3-p26.1 del/17q12 dup, 22q11.21 del, and 6q23.3-q24.1 del were identified in patients with inflammatory fever. The TNFAIP3 gene was included in the 6q23.3-q24.1 deletion fragment. Two patients with central fever were characterized by facial anomalies, developmental delay, seizures and no response to antipyretic drugs and were identified as carrying the de novo 18q22.3-q23 del. By performing a literature review, an additional 19 patients who had FUO and chromosomal abnormalities were identified. Trisomy 8, 6q23.2-q24.3 del and 18q22.3-q23 del were reported to present as fever, similar to the findings of our study. CONCLUSIONS We emphasized the important role of detecting chromosomal abnormalities in patients with FUO, especially in patients with systemic inflammatory manifestations or developmental delay. Identifying chromosomal abnormalities may change the diagnosis and management of patients with FUO.
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Wallace K, Greene E, Moya-Mendez M, Freemark M, Prange L, Mikati MA. Hypothalamic-pituitary dysfunction in alternating hemiplegia of childhood. Eur J Paediatr Neurol 2021; 32:1-7. [PMID: 33756210 DOI: 10.1016/j.ejpn.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/08/2021] [Accepted: 03/04/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many central nervous system disorders result in hypothalamic-pituitary (HP) axis dysfunction. Alternating Hemiplegia of Childhood (AHC) is usually caused by mutations in the ATP1A3 subunit of the Na+/K+ ATPase, predominantly affecting GABAergic interneurons. GABAergic interneurons and the ATP1A3 subunit are both important for function of the hypothalamus. However, whether HP dysfunction occurs in AHC and, if so, how such dysfunction manifests remains to be investigated. METHODS We conducted a retrospective review of a cohort of 50 consecutive AHC patients for occurrence of HP related manifestations and analyzed the findings of the 6 patients, from that cohort, with such manifestations. RESULTS Six out of 50 AHC patients manifested HP dysfunction. Three of these patients were mutation positive and 3 were mutation negative. Of the 6 patients with HP dysfunction, 3 had central precocious puberty. A fourth had short stature due to growth hormone deficiency. Two other patients had recurrent episodes of fever of unknown origin (FUO) diagnosed, after workups, as being secondary to central fever. All patients were evaluated and co-managed by pediatric neurology and endocrinology or rheumatology. CONCLUSION AHC was associated with HP dysfunction in about 12% of patients. Awareness of such dysfunction is important for anticipatory guidance and management particularly in the case of FUO which often presents a diagnostic dilemma. Our findings are also consistent with current understandings of the underlying pathophysiology of AHC and of the HP axis.
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Affiliation(s)
- Keri Wallace
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, 2301 Erwin Rd, Durham, NC, 27710, USA.
| | - Elizabeth Greene
- Division of Pediatric Endocrinology, Duke Children's Health Center, 2301 Erwin Rd, Durham, NC, 27710, USA.
| | - Mary Moya-Mendez
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, 2301 Erwin Rd, Durham, NC, 27710, USA.
| | - Michael Freemark
- Division of Pediatric Endocrinology, Duke Children's Health Center, 2301 Erwin Rd, Durham, NC, 27710, USA.
| | - Lyndsey Prange
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, 2301 Erwin Rd, Durham, NC, 27710, USA.
| | - Mohamad A Mikati
- Division of Pediatric Neurology and Developmental Medicine, Duke Children's Health Center, 2301 Erwin Rd, Durham, NC, 27710, USA.
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Tambasco N, Paoletti FP, Prato G, Mancardi MM, Prontera P, Giordano L, Grosso S, Romeo A, Pinto F, Savasta S, Peruzzi C, Romoli M, Striano P, Verrotti A, Belcastro V. Long-term follow-up in pediatric patients with paroxysmal hypothermia (Shapiro's syndrome). Eur J Paediatr Neurol 2018; 22:1081-1086. [PMID: 30195408 DOI: 10.1016/j.ejpn.2018.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/05/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Shapiro syndrome (SS) is characterized by spontaneous recurrent episodes of hypothermia, hyperhidrosis and corpus callosum (CC) agenesis. Less than 60 cases have been reported to date and the pathogenic mechanism as well as the prognosis of this syndrome are still debated. We describe the clinical features and long-term follow-up of a pediatric cohort of SS patients. METHODS We collected 13 (10 novel) pediatric cases of SS and report their long-term follow-up and neurological outcome. RESULTS All patients experienced recurring hypothermia, with body temperature below 35 °C during the episodes, often accompanied by hyperidrosis. CC agenesis was an inconstant structural feature in the present series (2/13 patients). Seven patients received antiepileptic drugs (AEDs) or other drug therapy for a mean period of 12 months. At long-term follow-up (mean = 61 months, range: 60-96), all individuals were free from episodes of paroxysmal hypothermia independently from previous AED use or other drug therapy. CONCLUSION Paroxysmal hypothermia, the core symptom of SS, behaved as a age-dependent feature in our cohort, supporting a good long-term prognosis for SS. A prompt diagnosis of SS is crucial to avoid unnecessary diagnostic investigations.
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Affiliation(s)
- Nicola Tambasco
- Neurology Department, University General Hospital, Perugia, Italy
| | | | - Giulia Prato
- Neuropsychiatry Unit, Department of Clinical and Surgical Neurosciences and Rehabilitation, "G. Gaslini" Institute, Genoa, Italy
| | - Maria Margherita Mancardi
- Neuropsychiatry Unit, Department of Clinical and Surgical Neurosciences and Rehabilitation, "G. Gaslini" Institute, Genoa, Italy
| | - Paolo Prontera
- Medical Genetics Unit, "S. Maria della Misericordia" Hospital, Perugia, Italy
| | - Lucio Giordano
- Child Neuropsychiatric Division, Spedali Civili, Brescia, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Pediatric Neurology Unit, Department of Molecular and Reproductive Medicine, University of Siena, Siena, Italy
| | - Antonino Romeo
- Pediatric Neurology Unit and Epilepsy Center, "Fatebenefratelli e Oftalmico" Hospital, Milano, Italy
| | - Francesca Pinto
- Department of Pediatrics, "Fatebenefratelli e Oftalmico" Hospital, Milano, Italy
| | - Salvatore Savasta
- Department of Paediatrics, University of Pavia, IRCCS Policlinico "San Matteo", Pavia, Italy
| | | | - Michele Romoli
- Neurology Department, University General Hospital, Perugia, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, "G. Gaslini" Institute, Genova, Italy
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Thermoregulatory Instability in Childhood: Linking the Normal Brain to Hypothalamic Storm. Case Rep Neurol Med 2016; 2016:3903854. [PMID: 27847661 PMCID: PMC5101378 DOI: 10.1155/2016/3903854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/11/2016] [Indexed: 11/25/2022] Open
Abstract
Central core temperature is tightly controlled by hypothalamic centers, a feature that makes sudden changes in body temperature very unusual. A dysfunction of these hypothalamic pathways leads to Shapiro's syndrome, comprising spontaneous hypothermia, hyperhidrosis, and corpus callosum dysgenesis. Although it may affect any age, usually it presents in childhood. Variants to this syndrome with completely normal brain anatomy have been consistently reported, expanding the clinical spectrum of the syndrome. Herein, we report the case of a 4-year-old girl with Shapiro's syndrome and unaffected corpus callosum.
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Topcu Y, Bayram E, Karaoglu P, Yis U, Kurul SH. The combination of thermal dysregulation and agenesis of corpus callosum: Shapiro's or/and reverse Shapiro's syndrome. Ann Indian Acad Neurol 2013; 16:716-9. [PMID: 24339619 PMCID: PMC3841640 DOI: 10.4103/0972-2327.120451] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 01/13/2013] [Accepted: 03/07/2013] [Indexed: 11/17/2022] Open
Abstract
Shapiro syndrome is an extremely rare condition consisting the clinical triad of recurrent hypothermia, hyperhydrosis and agenesis of the corpus callosum. On the other hand, reverse Shapiro's sydrome is characterized periodic hyperthermia and agenesis of the corpus callosum. Here, we describe a 3.5-year-old girl with complete agenesis of corpus callosum presenting with recurrent fever and vomiting. She also had hypothermia attacks with accompanying diaphoresis. To the best of our knowledge, there is no described case with episodes of hyperthermia, hypothermia, and vomiting associated with agenesis of the corpus callosum. Recurrent vomiting may be a newly defined symptom associated with these syndromes.
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Affiliation(s)
- Yasemin Topcu
- Department of Pediatrics, Dokuz Eylul University Medical Faculty, Division of Pediatric Neurology, İzmir, Turkey
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Kapoor S. Reverse Shapiro's syndrome: Hyperthermia in the scenario of agenesis of the corpus callosum. J Neurol Sci 2013; 334:196. [DOI: 10.1016/j.jns.2013.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
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Herlich A. Perioperative temperature elevation: not all hyperthermia is malignant hyperthermia. Paediatr Anaesth 2013; 23:842-50. [PMID: 23890328 DOI: 10.1111/pan.12244] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The objective of this review is to assist the readers, anesthesiologists, intensivists, and emergency physicians in making a more accurate diagnosis of perioperative fever or hyperthermia and subsequently choose the proper course of treatment. AIM To identify the many sources of perioperative fever and after a more accurate differential diagnosis, select appropriate treatment options. Most anesthesiologists, intensivists, and emergency physicians are not familiar with an expansive differential of perioperative fever. This article attempts to expose these physicians to that differential diagnosis. BACKGROUND Much of the medical literature has anecdotal reports, small case series, or limited reviews of the possible sources of hyperthermia or fever. This is especially true of the anesthesia literature. RESULTS A literature search was performed which identified many possible common and uncommon sources of fever. Some of these sources are quite relevant to the anesthesiologist. Other sources had potential relevance in obscure cases.
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Affiliation(s)
- Andrew Herlich
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA.
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Guha S, Guha G, Hashmi MA. A case of periodic fever with corpus callosum agenesis: reverse Shapiro's syndrome. J Pediatr Neurosci 2012; 7:153-4. [PMID: 23248704 PMCID: PMC3519082 DOI: 10.4103/1817-1745.102590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Suparna Guha
- Paediatrics Department, Vivekanand Institute of Medical Sciences, Kolkata, West Bengal, India
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Abstract
Hormonal imprinting takes place at the first encounter between the developing receptor and the target hormone, perinatally, causing life-long changes in the binding capacity of the receptor and the indexes influenced by it. Perinatal hormonal imprinting is absolutely needed for the maturation of receptor, however, at the same time, molecules similar to the target hormone (related hormones, synthetic drugs acting at receptor level, chemicals, environmental pollutants etc.) can cause faulty imprinting, also with (morphological, biochemical, receptorial, behavioral) consequences for life. Although imprinting is characteristic and inevitable perinatally, it can be provoked in any period of life in developing cells, especially at the weanling and adolescent age (late imprinting). There is no gene mutation during imprinting, however, the methylation pattern of the genes changes and that inherits epigenetically the imprinting, which is manifested in disposition to diseases or in diseases (e.g. tumor formation, metabolic syndrome). Imprinting is inherited between generations that could cause--in the present chemical world--evolutionary consequences. Thus, medicaments or preventive drugs, e.g. pregnancy protecting drugs or oral contraceptive pills should be given cautiously, especially in the critical periods, considering that consequences are manifested always after a long period (sometimes decades) or in the next generations.
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Affiliation(s)
- György Csaba
- Semmelweis Egyetem, Altalános Orvostudományi Kar Genetikai, Sejt- és Immunbiológiai Intézet, Budapest, Pf. 370 1445.
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