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Contreras-Cubas C, Barajas-Olmos F, Frayre-Martínez MI, Siordia-Reyes G, Guízar-Sánchez CC, García-Ortiz H, Orozco L, Baca V. Dysferlinopathy misdiagnosed with juvenile polymyositis in the pre-symptomatic stage of hyperCKemia: a case report and literature review. BMC Med Genomics 2022; 15:139. [PMID: 35725460 PMCID: PMC9208210 DOI: 10.1186/s12920-022-01284-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/10/2022] [Indexed: 12/05/2022] Open
Abstract
Background Dysferlinopathy encompasses a group of rare muscular dystrophies caused by recessive mutations in the DYSF gene. The phenotype ranges from asymptomatic elevated serum creatine kinase (hyperCKemia) to selective and progressive involvement of the proximal and/or distal muscles of the limbs. Bohan and Peter criteria are the most widely used for the diagnosis of polymyositis, but they have limitations and can misclassify muscular dystrophies with inflammation as polymyositis. Most dysferlinopathy patients have muscle biopsies with inflammation and thus are vulnerable to misdiagnosis with polymyositis and inappropriate treatment with steroids and immunosuppressors.
Case presentation We describe a 14 years-old male patient who was referred for assessment of asymptomatic hyperCKemia (26,372 IU/L). An X-linked dystrophinopathy initially was ruled out by direct genetic testing. Juvenile polymyositis was considered based on muscle biopsy, creatine kinase levels, and electromyography changes. Corticosteroid treatment triggered proximal lower limb muscular weakness, and no full muscular strength recovery was observed after corticosteroid withdrawal. Based on these observations, a limb-girdle muscular dystrophy (LGMD) was suspected, and LGMDR2 was confirmed by whole exome sequencing. Conclusion We report a dysferlinopathy patient who was misdiagnosed with juvenile polymyositis and explore in a literature review how common such misdiagnoses are. With diagnosis based only on routine clinicopathological examinations, distinguishing an inflammatory myopathy from dysferlinopathy is quite difficult. We suggest that before establishing a diagnosis of “definite” or “probable” juvenile polymyositis, according to Bohan and Peter or current ACR/EULAR criteria, a muscular dystrophy must first be ruled out.
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Affiliation(s)
- Cecilia Contreras-Cubas
- Immunogenomics and Metabolic Diseases Laboratory, National Institute of Genomic Medicine, SS, Mexico City, Mexico
| | - Francisco Barajas-Olmos
- Immunogenomics and Metabolic Diseases Laboratory, National Institute of Genomic Medicine, SS, Mexico City, Mexico
| | | | | | - Claudia C Guízar-Sánchez
- Department of Physical Medicine and Rehabilitation, Hospital de Pediatría, CMN Siglo XXI IMSS, Mexico City, Mexico
| | - Humberto García-Ortiz
- Immunogenomics and Metabolic Diseases Laboratory, National Institute of Genomic Medicine, SS, Mexico City, Mexico
| | - Lorena Orozco
- Immunogenomics and Metabolic Diseases Laboratory, National Institute of Genomic Medicine, SS, Mexico City, Mexico
| | - Vicente Baca
- Department of Rheumatology, Hospital de Pediatría, CMN Siglo XXI IMSS, Mexico City, Mexico.
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Khadilkar SV, Halani HA, Dastur R, Gaitonde PS, Oza H, Hegd M. Genetic Appraisal of Hereditary Muscle Disorders In A Cohort From Mumbai, India. J Neuromuscul Dis 2022; 9:571-580. [PMID: 35723113 DOI: 10.3233/jnd-220801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hereditary muscle disorders are clinically and genetically heterogeneous. Limited information is available on their genetic makeup and their prevalence in India. OBJECTIVE To study the genetic basis of prevalent hereditary myopathies. MATERIAL AND METHODS This is a retrospective study conducted at a tertiary care center. The study was approved by the institutional ethics board. The point of the collection was the genetic database. The genetic data of myopathy patients for the period of two and half years (2019 to mid-2021) was evaluated. Those with genetic diagnoses of DMD, FSHD, myotonic dystrophies, mitochondriopathies, and acquired myopathies were excluded. The main outcome measures were diagnostic yield and the subtype prevalence with their gene variant spectrum. RESULTS The definitive diagnostic yield of the study was 39% (cases with two pathogenic variants in the disease-causing gene). The major contributing genes were GNE (15%), DYSF (13%), and CAPN3 (7%). Founder genes were documented in Calpainopathy and GNE myopathy. The uncommon myopathies identified were Laminopathy (0.9%), desminopathy (0.9%), and GMPPB-related myopathy (1.9%). Interestingly, a small number of patients showed pathogenic variants in more than one myopathy gene, the multigenic myopathies. CONCLUSION This cohort study gives hospital-based information on the prevalent genotypes of myopathies (GNE, Dysferlinopathy, and calpainopathy), founder mutations, and also newly documents the curious occurrence of multigenicity in a small number of myopathies.
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Affiliation(s)
| | | | - Rashna Dastur
- Centre for Advanced Molecular Diagnostics in Neuromuscular Disorders (CAMDND), Mumbai, India
| | - Pradnya Satish Gaitonde
- Centre for Advanced Molecular Diagnostics in Neuromuscular Disorders (CAMDND), Mumbai, India
| | - Harsh Oza
- Department of Neurology, Bombay Hospital, Mumbai, India
| | - Madhuri Hegd
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, United States, PerkinElmer Genomics, Global Laboratory Services
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Tang J, Song X, Ji G, Wu H, Sun S, Lu S, Li Y, Zhang C, Zhang H. A novel mutation in the DYSF gene in a patient with a presumed inflammatory myopathy. Neuropathology 2018; 38:433-437. [PMID: 29799141 DOI: 10.1111/neup.12474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 01/30/2023]
Abstract
Dysferlinopathy, a progressive muscular dystrophy, results from mutations in the Dysferlin gene (DYSF, MIM*603009). Traditional diagnosis relies on the reduction or absence of dysferlin. However, altered dysferlin has been observed in other myopathies, leading to a precise diagnosis through molecular genetics. In this study, we report a patient who was previously misdiagnosed as inflammatory myopathy based on routine clinicopathological examinations alone. However, muscle biopsy specimens were analyzed further by immunohistochemistry of muscular dystrophy-related proteins, and gene-targeted next generation sequencing (NGS) was used to correctly identify muscular dystrophy. DNA was sequenced with NGS and the detected mutation was verified by Sanger sequencing. Our targeted NGS found a novel missense mutation (c.5392G > A) in the DYSF gene, allowing correct diagnosis of LGMD2B in our patient. We discovered of a novel missense mutation in the DYSF gene and have broadened the DYSF mutation spectrum, which may be correlated in patients with presumed dysferlinopathy, especially when lymphocytic infiltration is observed.
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Affiliation(s)
- Jin Tang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiahzuang, China
| | - Xueqin Song
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiahzuang, China
| | - Guang Ji
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiahzuang, China
| | - Hongran Wu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiahzuang, China
| | - Shuyan Sun
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiahzuang, China
| | - Shan Lu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiahzuang, China
| | - Yuan Li
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiahzuang, China
| | - Chi Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiahzuang, China
| | - Huiqing Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiahzuang, China
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Khadilkar SV, Faldu HD, Patil SB, Singh R. Limb-girdle Muscular Dystrophies in India: A Review. Ann Indian Acad Neurol 2017; 20:87-95. [PMID: 28615891 PMCID: PMC5470147 DOI: 10.4103/aian.aian_81_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Limb-girdle muscular dystrophies (LGMDs) are common in India. Information on LGMDs has been gradually evolving in the recent years. This information is scattered in case series and case studies. The aim of this study is to collate available Indian information on LGMDs and put it in perspective. PubMed search using keywords such as limb-girdle muscular dystrophies in India, sarcoglycanopathies, dysferlinopathy, calpainopathy, and GNE myopathy was carried out. The published information on LGMDs in Indian context suggests that dysferlinopathy, calpainopathy, sarcoglycanopathies, and other myopathies such as GNE myopathy are frequently seen in India. Besides these, anecdotal reports of many other forms are available, some with genetic support and others showing immunocytochemical defects. The genotypic information on LGMDs is gradually evolving and founder mutations have been detected in selected populations. Further multicenter studies are necessary to document the incidence and prevalence of these common conditions in India.
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Affiliation(s)
| | - Hinaben Dayalal Faldu
- Department of Neurology, Grant Government Medical College and J. J. Hospital, Mumbai, Maharashtra, India
| | - Sarika Bapuso Patil
- Department of Neurology, Grant Government Medical College and J. J. Hospital, Mumbai, Maharashtra, India
| | - Rakesh Singh
- Department of Neurology, Grant Government Medical College and J. J. Hospital, Mumbai, Maharashtra, India
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Fanin M, Angelini C. Progress and challenges in diagnosis of dysferlinopathy. Muscle Nerve 2016; 54:821-835. [DOI: 10.1002/mus.25367] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Marina Fanin
- Department of Neurosciences; University of Padova; Biomedical Campus “Pietro d'Abano”, via Giuseppe Orus 2B 35129 Padova Italy
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Woudt L, Di Capua GA, Krahn M, Castiglioni C, Hughes R, Campero M, Trangulao A, González-Hormazábal P, Godoy-Herrera R, Lévy N, Urtizberea JA, Jara L, Bevilacqua JA. Toward an objective measure of functional disability in dysferlinopathy. Muscle Nerve 2015; 53:49-57. [DOI: 10.1002/mus.24685] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Lisanne Woudt
- Unidad Neuromuscular; Departamento de Neurología y Neurocirugía; Hospital Clínico Universidad de Chile, Santos Dumont 999, 2do. piso; Sector E. Independencia 8380456 Santiago Chile
| | - Gabriella A. Di Capua
- Programa de Genética Humana; Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile; Santiago Chile
| | - Martin Krahn
- Aix Marseille Université; INSERM, Medical Genetics and Functional Genomics; Unité Mixte de Recherche_S 910 Marseille France
- Assistance Publique - Hôpitaux de Marseille; Département de Génétique Médicale; Hôpital Timone Enfants; Marseille France
| | - Claudia Castiglioni
- Unidad de Neurología; Departamento de Pediatría; Clínica Las Condes; Santiago Chile
| | - Ricardo Hughes
- Unidad Neuromuscular; Departamento de Neurología y Neurocirugía; Hospital Clínico Universidad de Chile, Santos Dumont 999, 2do. piso; Sector E. Independencia 8380456 Santiago Chile
| | - Mario Campero
- Unidad Neuromuscular; Departamento de Neurología y Neurocirugía; Hospital Clínico Universidad de Chile, Santos Dumont 999, 2do. piso; Sector E. Independencia 8380456 Santiago Chile
| | - Alejandra Trangulao
- Programa Anatomía y Biología del Desarrollo; Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile; Santiago Chile
| | - Patricio González-Hormazábal
- Programa de Genética Humana; Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile; Santiago Chile
| | - Raúl Godoy-Herrera
- Programa de Genética Humana; Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile; Santiago Chile
| | - Nicolas Lévy
- Aix Marseille Université; INSERM, Medical Genetics and Functional Genomics; Unité Mixte de Recherche_S 910 Marseille France
- Assistance Publique - Hôpitaux de Marseille; Département de Génétique Médicale; Hôpital Timone Enfants; Marseille France
| | - Jon Andoni Urtizberea
- Unité Neuromusculaire, Hôpital Marin de Hendaye; Assistance Publique - Hôpitaux de Paris Hendaye France
| | - Lilian Jara
- Programa de Genética Humana; Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile; Santiago Chile
| | - Jorge A. Bevilacqua
- Unidad Neuromuscular; Departamento de Neurología y Neurocirugía; Hospital Clínico Universidad de Chile, Santos Dumont 999, 2do. piso; Sector E. Independencia 8380456 Santiago Chile
- Programa Anatomía y Biología del Desarrollo; Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile; Santiago Chile
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Ankala A, Tamhankar PM, Valencia CA, Rayam KK, Kumar MM, Hegde MR. Clinical Applications and Implications of Common and Founder Mutations in Indian Subpopulations. Hum Mutat 2014; 36:1-10. [DOI: 10.1002/humu.22704] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 09/16/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Arunkanth Ankala
- Department of Human Genetics; Emory University School of Medicine; Atlanta Georgia
| | - Parag M. Tamhankar
- ICMR Genetic Research Center; National Institute for Research in Reproductive Health; Mumbai Maharashtra India
| | - C. Alexander Valencia
- Division of Human Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Department of Pediatrics; University of Cincinnati Medical School; Cincinnati Ohio
| | - Krishna K. Rayam
- Department of Biosciences; CMR Institute of Management Studies; Bangalore Karnataka India
| | - Manisha M. Kumar
- Department of Biosciences; CMR Institute of Management Studies; Bangalore Karnataka India
| | - Madhuri R. Hegde
- Department of Human Genetics; Emory University School of Medicine; Atlanta Georgia
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Ankala A, Kohn JN, Dastur R, Gaitonde P, Khadilkar SV, Hegde MR. Ancestral founder mutations in calpain-3 in the Indian Agarwal community: historical, clinical, and molecular perspective. Muscle Nerve 2013; 47:931-7. [PMID: 23666804 DOI: 10.1002/mus.23763] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2012] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Clinical heterogeneity of limb-girdle muscular dystrophies (LGMDs, 24 known subtypes), which includes overlapping phenotypes and varying ages of onset and morbidity, adds complexity to clinical and molecular diagnoses. METHODS To diagnose LGMD subtype, protein analysis, using immunohistochemistry (IHC) and immunoblotting, was followed by gene sequencing through a panel approach (simultaneous sequencing of known LGMD genes) in 9 patients from unrelated families of the Indian Agarwal community. Haplotype studies were performed by targeted SNP genotyping to establish mutation segregation. RESULTS We identified 2 founder mutations in CAPN3, a missense (c.2338G>C; p.D780H) and a splice-site (c.2099-1G>T) mutation, on 2 different haplotype backgrounds. The patients were either heterozygous for both or homozygous for either of these mutations. CONCLUSIONS Founder mutations have immediate clinical application, at least in selected population groups. Clinically available gene panels may provide a definitive molecular diagnosis for heterogeneous disorders such as LGMD.
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Affiliation(s)
- Arunkanth Ankala
- Department of Human Genetics, Emory University School of Medicine, 615 Michael Street, Atlanta, Georgia 30322, USA
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