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Vagha JD, Wazurkar A, Madke B, Lohiya S, Wandile S, Vagha K, Javvaji CK, Naseri S. Beyond Skin Deep: A Case Report of Infantile Systemic Hyalinosis in a Six-Month-Old Infant. Cureus 2024; 16:e59510. [PMID: 38826988 PMCID: PMC11143919 DOI: 10.7759/cureus.59510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
A rare autosomal recessive condition called infantile systemic hyalinosis (ISH) is characterized by early-onset skin lesions that progress to the formation of numerous contractures. The underlying disease is the progressive accumulation of hyaline substances in many tissues. We are presenting the case of a male infant who was referred for evaluation and management at the age of six months. The infant had a history of recurrent episodes of diarrhea and showed limited movement in all four limbs. Upon physical examination, hyperpigmented papulonodular lesions on bony prominences and perianal regions were found, coupled with contractures in the elbow and knee joints. Hyaline deposition in the mid-dermal region was confirmed by histopathological analysis of a skin biopsy sample. The baby also had acute otitis media, which needed to be treated with antibiotics. Parents were counseled regarding the disease's diagnosis, complications, prognosis, and inheritance pattern. This case highlights the clinical presentation, diagnostic process, and management strategies employed in the care of ISH, emphasizing the importance of early recognition and multidisciplinary management in mitigating its devastating effects.
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Affiliation(s)
- Jayant D Vagha
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ajinkya Wazurkar
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhushan Madke
- Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sham Lohiya
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shailesh Wandile
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Keta Vagha
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Chaitanya Kumar Javvaji
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suhit Naseri
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Gupta P, Thakur V, Behera B. Multiple nodular swellings with gingival hyperplasia and joint contractures. Pediatr Dermatol 2024; 41:336-338. [PMID: 38014603 DOI: 10.1111/pde.15478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/03/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Priyansh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Vishal Thakur
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Biswanath Behera
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, India
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3
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Oswal RM, Prasad SS, Manohar N, Pise GA, Rao K. Overlapping Hyaline Fibromatosis Syndrome: A Rare Case of Juvenile Hyaline Fibromatosis and Infantile Systemic Hyalinosis. Cureus 2022; 14:e27947. [PMID: 36120216 PMCID: PMC9464707 DOI: 10.7759/cureus.27947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 11/09/2022] Open
Abstract
Juvenile hyaline fibromatosis (JHF) and infantile systemic hyalinosis (ISF) are rare progressive, fatal autosomal recessive fibromatosis disorders that are characterized by the deposition of hyaline in various tissues. Mutations in capillary morphogenesis gene 2 are responsible for both of these conditions. These disorders usually present with fleshy, papular lesions, joint contractures, gingival hyperplasia, and persistent diarrhoea. An 18-month-old boy presented with multiple scalp abscesses, facial nodules, gingival hypertrophy, hypertrophic verrucous plaques and joint contractures with unique dermoscopic features and a history of recurrent diarrhoea and infections. Histopathological examination following skin biopsy revealed deposition of hyaline in the stroma and subcutaneous tissues. JHF is a differential diagnosis in children who present with multiple scalp nodules. Here, we report the case of overlapping features of JHF and ISH. The evolution of this case provides a special opportunity to further understand the pathogenesis and clinical characterization of hyaline fibromatosis syndrome.
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Baroud S, Alawadhi A. A Severe Case of Infantile Systemic Hyalinosis in an Asian Child: A Product of Consanguinity. Cureus 2021; 13:e16433. [PMID: 34414050 PMCID: PMC8365122 DOI: 10.7759/cureus.16433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/30/2022] Open
Abstract
Infantile systemic hyalinosis (ISH) is a rare, autosomal recessive disorder characterized by widespread abnormal growth of hyalinized fibrous tissue in skin and mucosae. The typical clinical picture consists of the development of joint contractures, skin lesions, and severe, chronic pain. We report the case of a 2-year-old Pakistani girl, who presented to our clinic with papulonodular lesions, gingival hyperplasia, hypotonia, and joint contractures. Skin biopsy revealed hyaline deposits, and genetic testing revealed a mutation in the protein Anthrax toxin receptor 2 (ANTXR2).
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Affiliation(s)
- Sumer Baroud
- Department of Dermatology, Medical University of Sharjah, Sharjah, ARE
| | - Ameen Alawadhi
- Department of Dermatology, Salmaniya Medical Complex, Manama, BHR
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Härter B, Benedicenti F, Karall D, Lausch E, Schweigmann G, Stanzial F, Superti‐Furga A, Scholl‐Bürgi S. Clinical aspects of Hyaline Fibromatosis Syndrome and identification of a novel mutation. Mol Genet Genomic Med 2020; 8:e1203. [PMID: 32196989 PMCID: PMC7284039 DOI: 10.1002/mgg3.1203] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Hyaline fibromatosis syndrome is an autosomal recessive disease caused by mutations in ANTXR2 which leads to loss of function of the transmembrane protein anthrax toxin receptor 2. It is distinguished by characteristic skin lesions, gingival hyperplasia, joint and bone disease, and systemic involvement. METHODS Based on the case of an 11-year-old female patient with typical features of hyaline fibromatosis syndrome and the underlying pathogenic compound heterozygote variants in ANTXR2 we discuss the genetic and clinical aspects of hyaline fibromatosis syndrome. RESULTS The novel mutation in ANTXR2 (c.1223T>C, p.Leu408Pro variant) seems to allow for a protracted course of the disease. CONCLUSION Our findings add to the phenotypic, genetic, and biochemical spectrum of hyaline fibromatosis syndrome.
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Affiliation(s)
- Bettina Härter
- Division of Pediatric SurgeryDepartment of Visceral, Transplant and Thoracic SurgeryCenter of Operative MedicineInnsbruck Medical UniversityInnsbruckAustria
| | - Francesco Benedicenti
- Clinical Genetics Service and South Tyrol Coordination Center for Rare DiseasesDepartment of PediatricsRegional Hospital of BolzanoBolzanoItaly
| | - Daniela Karall
- Department of Pediatrics IInnsbruck Medical UniversityInnsbruckAustria
| | - Ekkehard Lausch
- Pediatric Genetics SectionDepartment of PediatricsUniversity of FreiburgFreiburgGermany
| | | | - Franco Stanzial
- Clinical Genetics Service and South Tyrol Coordination Center for Rare DiseasesDepartment of PediatricsRegional Hospital of BolzanoBolzanoItaly
| | - Andrea Superti‐Furga
- Division of Genetic MedicineLausanne University HospitalUniversity of LausanneLausanneSwitzerland
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6
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Schussler E, Linkner RV, Levitt J, Mehta L, Martignetti JA, Oishi K. Protein-losing enteropathy and joint contractures caused by a novel homozygous ANTXR2 mutation. ACTA ACUST UNITED AC 2018; 8:17-21. [PMID: 30050362 PMCID: PMC6057141 DOI: 10.2147/agg.s159077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Infantile systemic hyalinosis (ISH) is a rare autosomal recessive disorder and an allelic form of hyaline fibromatosis syndrome that is caused by mutations in the ANTRX2 gene encoding the transmembrane anthrax toxin receptor 2. Its main features include characteristic skin lesions, joint contractures, persistent diarrhea, and failure to thrive due to accumulation of hyaline material in multiple organs. The resulting severe malnutrition can cause death in early infancy. Because of its rarity and high fatality rate, timely diagnosis is difficult and ISH may be underdiagnosed. In this report, we describe a 10-month-old male with severe protein-losing enteropathy, skin lesions, and painful joint contractures, diagnosed with ISH based on skin his-topathology and identification of a novel homozygous ANTRX2 mutation, c.1127_1128delTG (p.V376Gfs*14). While its clinical outcome is poor without curative treatment, establishing a diagnosis of ISH starting from clinical suspicion to molecular analysis is important for appropriate medical management and for risk and carrier assessment of family members.
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Affiliation(s)
- Edith Schussler
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rita V Linkner
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jacob Levitt
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lakshmi Mehta
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John A Martignetti
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kimihiko Oishi
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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7
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Kalgaonkar PS, Wade M, Warke C, Makhecha M, Khare M. Juvenile Hyaline Fibromatosis- A Rare Autosomal Recessive Disease. J Clin Diagn Res 2017; 11:SD04-SD06. [PMID: 28892992 DOI: 10.7860/jcdr/2017/25280.10293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 05/11/2017] [Indexed: 11/24/2022]
Abstract
Systemic hyalinosis is inherited as an autosomal recessive disease. It may also be referred to as Fibromatosis hyalinica multiplex juvenilis and Murray-Puretic-Drescher syndrome. A four and a half-year-old female child presented with multiple soft tissue swellings involving the nose, orbital ridges, ears, bony prominences of the ulna and tibia and the parietal and occipital prominence and had gum hypertrophy. The diagnosis of this rare condition was based upon clinicopathological correlation, wherein the histopathological examination of cutaneous lesions reveals accumulation of hyaline material with fibroblast in the dermis. A multidisciplinary approach helped in correct diagnosis, management and in providing counseling for the parents. The child's parents were counseled about the surgical excision of the lesion; however, the parents opted for non-surgical conservative management.
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Affiliation(s)
- Prarthana Sameer Kalgaonkar
- Consultant, Department of Paediatrics, Dr R N Cooper Hospital and Hindu Hriday Samrat Balasaheb Thackrey Medical College, Vile Parle West, Mumbai, India
| | - Minal Wade
- Associate Professor, Department of Paediatrics, Dr R N Cooper Hospital and Hindu Hriday Samrat Balasaheb Thackrey Medical College, Vile Parle West, Mumbai, India
| | - Charusheela Warke
- Associate Professor, Department of Paediatrics, Dr R N Cooper Hospital and Hindu Hriday Samrat Balasaheb Thackrey Medical College, Vile Parle West, Mumbai, India
| | - Meena Makhecha
- Associate Professor, Department of Dermatology, Dr R N Cooper Hospital and Hindu Hriday Samrat Balasaheb Thackrey Medical College, Vile Parle West, Mumbai, India
| | - Manisha Khare
- Professor, Department of Pathology, Dr R N Cooper Hospital and Hindu Hriday Samrat Balasaheb Thackrey Medical College, Vile Parle West, Mumbai, India
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8
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Sugiura K, Ohno A, Kono M, Kitoh H, Itomi K, Akiyama M. Hyperpigmentation over the metacarpophalangeal joints and the malleoli in a case of hyaline fibromatosis syndrome with ANTXR2 mutations. J Eur Acad Dermatol Venereol 2016; 30:e44-e46. [PMID: 26335786 DOI: 10.1111/jdv.13290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K Sugiura
- Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - A Ohno
- Department of Neurology, Aichi Children's Health and Medical Center, 426, 7chome Morioka-cho, Obu, 474-8710, Aichi, Japan
| | - M Kono
- Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - H Kitoh
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - K Itomi
- Department of Neurology, Aichi Children's Health and Medical Center, 426, 7chome Morioka-cho, Obu, 474-8710, Aichi, Japan
| | - M Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan.
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9
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Hammoudah SAF, El-Attar LM. Infantile systemic hyalinosis: Report of two severe cases from Saudi Arabia and review of the literature. Intractable Rare Dis Res 2016; 5:124-8. [PMID: 27195198 PMCID: PMC4869580 DOI: 10.5582/irdr.2016.01003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Infantile systemic hyalinosis (ISH) (OMIM 228600) is a rare fatal autosomal recessive disorder characterized by extensive deposition of hyaline material in many tissues. Consanguinity has been recorded in many cases. Herein we present two new Saudi cases with review of the literature. Our first proband was a 9 month-old male who was the first baby for parents descended from a closed consanguineous pedigree. The second proband was a 13 month-old male who was the first baby for consanguineous parents (3(rd) C). Both cases presented with bilateral painful limited limb movement with joints contractures, low birth weight (< P5), severe generalized stiff skin, hyper-pigmented skin over bony prominences, fleshy perianal masses and gingival hypertrophy. The first child died at 18(th) month as a result of recurrent chest infections. The second proband showed a severe progressive course of joint contractures, and died at 19(th) month because of failure to thrive and recurrent infections. Although the clinical features of ISH are characteristic, the disease is under/miss diagnosed. The role of consanguinity needed to be highlighted to the community. Careful clinical examination and molecular diagnosis will be helpful for genetic counseling, prenatal diagnosis and early treatment.
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Affiliation(s)
- Sahar Ahmed Fathi Hammoudah
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
- Address correspondence to: Dr. Sahar AF Hammoudah, Department of Clinical and Chemical Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt. E-mail:
| | - Lama Mohammed El-Attar
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
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10
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Krasuska-Sławińska E, Polnik D, Rokicki D, Koeber B. Treatment of Massive Labial and Gingival Hypertrophy in a Patient With Infantile Systemic Hyalinosis-A Case Report. J Oral Maxillofac Surg 2015; 73:1962.e1-5. [PMID: 26207694 DOI: 10.1016/j.joms.2015.06.176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 06/26/2015] [Accepted: 06/27/2015] [Indexed: 10/23/2022]
Abstract
Infantile systemic hyalinosis (ISH) is a rare autosomal recessive disorder caused by a mutation in the ANTXR2 gene encoding a transmembranous protein involved in endothelial development. The ANTXR2 (also known as CMG2) locus is on chromosome 4q21. ISH is a common disorder in children of consanguineous parents in Arab countries. Symptoms of ISH manifest within the first months of life as progressive painful joint contractures and edema, hyperpigmentation of the skin, cutaneous nodules, persistent diarrhea with protein-losing enteropathy, and recurrent infections. Children affected by ISH often die undiagnosed in infancy. Histopathologic examination shows hyaline deposits in the skin, skeletal muscles, cardiac muscle, lymph nodes, adrenal glands, gastrointestinal tract, thyroid, and spleen. Hyaline deposits are the result of leakage of plasma components to the perivascular space owing to defective endothelial morphogenesis. ISH manifests most often in the facial region. Patients develop hypertrophy of labial and buccal tissues and massive gingival overgrowths, which impair oral food intake and maintenance of satisfactory oral hygiene. The differential diagnosis of ISH should consider juvenile systemic hyalinosis (an allelic variant of ISH), Winchester syndrome, systemic fibromatosis, stiff skin syndrome, lipoid proteinosis, mucopolysaccharidosis, sphingolipidosis, and mucolipidosis. This report describes a case of massive labial and gingival hypertrophy in a 6-year-old boy with ISH.
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Affiliation(s)
- Ewa Krasuska-Sławińska
- Department Head, Dental Surgery Clinic, Children's Memorial Health Institute, Warsaw, Poland.
| | - Dariusz Polnik
- Assistant, Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland
| | - Dariusz Rokicki
- Assistant, Department of Metabolic Diseases, Children's Memorial Health Institute, Warsaw, Poland
| | - Bogumiła Koeber
- Resident, Dental Surgery Clinic, Children's Memorial Health Institute, Warsaw, Poland
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11
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Al Sinani S, Al Murshedy F, Abdwani R. Infantile systemic hyalinosis: a case report with a novel mutation. Oman Med J 2013; 28:53-5. [PMID: 23386947 DOI: 10.5001/omj.2013.12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 11/12/2012] [Indexed: 11/03/2022] Open
Abstract
Infantile Systemic Hyalinosis (ISH) (OMIM 236490) is a rare, progressive and fatal autosomal recessive disorder characterized by multiple subcutaneous skin nodules, gingival hypertrophy, osteopenia, joint contractures, failure to thrive, diarrhea with protein losing enteropathy, and frequent infections. There is diffuse deposition of hyaline material in the skin, gastrointestinal tract, muscle and endocrine glands. It is caused by mutations in the ANTXR2 (also known as CMG2) gene, which encodes a trans-membranous protein involved in endothelial development and basement membrane-extracellular matrix assembly. We describe a child with classical features of ISH presenting in infancy with severe chronic debilitating pain and progressive joint contractures. The diagnosis was confirmed by molecular DNA sequencing of ANTXR2 gene which revealed a novel homozygous mutation not previously reported; 79 bp deletion of the entire exon 11 (c.867_945del, p.E289DfsX22). Although this is the first reported case of ISH in Oman, we believe that the disease is under-diagnosed since children affected with this lethal disease pass away early in infancy prior to establishing a final diagnosis.
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Affiliation(s)
- Siham Al Sinani
- Department of Child Health, Sultan Qaboos University Hospital, Al Khoud, Sultanate of Oman
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12
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Madke B, Kharkar V, Mahajan S, Chikhalkar S, Khopkar U. Infantile systemic hyalinosis: A case report and review of literature. Indian Dermatol Online J 2012; 1:10-3. [PMID: 23130184 PMCID: PMC3481416 DOI: 10.4103/2229-5178.73250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report a case of infantile systemic hyalinosis in a 3.5-month-old male child born out of consanguineous marriage. He presented with multiple brownish raised lesions over bony prominences. He had also developed difficulty in movement of limbs and as a result developed severe flexion joint contractures. There was history of similar complaints in elder sibling who died at the age of 5 months due to repeated episodes of pneumonia. Skin biopsy from one of the papulonodular lesions showed increased amount of amorphous hyaline matrix, which was Periodic Acid Schiff positive with scattered fibroblasts. Though classical, we report this case for its rarity in western India.
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Affiliation(s)
- Bhushan Madke
- Department of Dermatology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India
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13
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Fong K, Rama Devi AR, Lai-Cheong JE, Chirla D, Panda SK, Liu L, Tosi I, McGrath JA. Infantile systemic hyalinosis associated with a putative splice-site mutation in the ANTXR2 gene. Clin Exp Dermatol 2012; 37:635-8. [PMID: 22300424 DOI: 10.1111/j.1365-2230.2011.04287.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Infantile systemic hyalinosis (ISH) is a rare autosomal recessive genetic disorder characterized by dermal and subcutaneous fibromatosis, joint contractures and bone deformities. The condition usually presents at birth, resulting in death in infancy. ISH is caused by mutations in the anthrax toxin receptor 2 gene, ANTXR2, also known as CMG2. We report an Indian child with ISH in whom we identified a homozygous acceptor splice site mutation, IVS2-4G>A. In silico analysis of this sequence showed that it changed predicted cryptic splicing, leading to out-of-frame transcripts and little, if any, functional protein. Mutations in the ANTXR2 gene can also cause juvenile hyaline fibromatosis (JHF). Although there are currently no effective treatments for ISH or JHF, identification of pathogenetic mutations in the ANTXR2 gene makes DNA-based prenatal diagnosis feasible for subsequent pregnancies.
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Affiliation(s)
- K Fong
- St John's Institute of Dermatology, King's College London (Guy's Campus), London, UK
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14
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Olczak-Kowalczyk D, Krasuska-Slawinska E, Rokicki D, Pronicki M. Case report: Infantile systemic hyalinosis: a dental perspective. Eur Arch Paediatr Dent 2011; 12:224-6. [PMID: 21806909 DOI: 10.1007/bf03262812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Infantile systemic hyalinosis is a rare genetic disorder which involves accumulation of hyaline in the skin, bones, mucous membranes, and occasionally, also in internal organs. The major manifestations include painful articular contractures, cutaneous lesions (hyperpigmentation, subcutaneous nodules), malnutrition resulting from diarrhoea, gingival, labial and buccal hypertrophy. CASE REPORT The phenotype characteristics of infantile systemic hyalinosis (ISH) in a two year old boy were present. The characteristics of flattered occiput, limited limb movements and articular abnormalities of elbows and knees. Dental findings showed excessive gingival hypertrophy completely covering maxillary and mandibular teeth treatment. The gingival hypertrophy was surgically treated by gingivectomy under general anaesthesia. FOLLOWUP: The patient showed a full constellation of clinical manifestations of the disease. Despite the surgical intervention no improvement in oral hygiene was observed. CONCLUSIONS Surgical treatment of the gingival hypertrophy was the treatment of choice.
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Affiliation(s)
- D Olczak-Kowalczyk
- Department of Pediatric Dentistry, Medical University of Warsaw, ul. Miodowa 18 Warsaw 00-246, Warsaw, Poland.
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Mallet S, Boye T, Hesse S, Fournier B, Guennoc B, Carsuzaa F. [Juvenile hyaline fibromatosis]. Ann Dermatol Venereol 2010; 137:364-8. [PMID: 20470917 DOI: 10.1016/j.annder.2010.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Accepted: 01/08/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Juvenile hyaline fibromatosis and infantile systemic hyalinosis are two rare autosomal recessive diseases arising from mutation in the capillary morphogenesis factor-2 gene. They are characterized by accumulation of hyaline material, in the skin in the first instance and in other organs in the second. We describe a case of juvenile hyaline fibromatosis. CASE REPORT A 2-year-old girl presented gingival hyperplasia, skin papules, subcutaneous nodules and joints and bones lesion. A diagnosis of juvenile hyaline fibromatosis was suggested and this was confirmed by histopathology and genetic analyses. The patient presented frequent episodes of diarrhoea, which is evocative of infantile systemic hyalinosis. DISCUSSION This case clearly illustrates the wide phenotypic range of juvenile hyaline fibromatosis. Diagnosis must be made as soon as possible to avoid cosmetic and functional handicap.
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Affiliation(s)
- S Mallet
- Service de dermatologie des Armées, hôpital d'instruction des Armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon-Naval, France.
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Klebanova Y, Schwindt C. Infantile Systemic Hyalinosis: A Case Report of Compromised Cellular and Humoral Branches of the Immune System Leading to Infections. ACTA ACUST UNITED AC 2009; 22:127-130. [PMID: 20563226 DOI: 10.1089/pai.2009.0011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Infantile systemic hyalinosis (ISH) is a rare disorder characterized by hyaline deposition in the skin as well as visceral organs. Though commonly associated with a protein losing enteropathy (PLE) and loss of immunoglobulins the profile of cellular and humoral branches of the immune system has not previously been described. We describe the immune system deficits in a case of ISH associated with PLE and infections. A history of multiple infections prompted an immunocompetency evaluation in a patient with ISH and PLE. Low immunoglobulin G (IgG), poorly protective pneumococcal titers, and nonresponse to Candida on lymphocyte transformation in the face of increasing infections lead to the diagnosis of a combined immunodeficiency. This is the first case report detailing quantitative and qualitative deficits of the humoral and cellular branches of the immune system in a patient with ISH. The understanding of the different aspects of this disease including the immune deficits impacts not only prognosis but also end-of-life decisions as well.
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Affiliation(s)
- Yana Klebanova
- Department of Pediatrics, University of California, Irvine, Orange, California
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Nofal A, Sanad M, Assaf M, Nofal E, Nassar A, Almokadem S, Attwa E, Elmosalamy K. Juvenile hyaline fibromatosis and infantile systemic hyalinosis: a unifying term and a proposed grading system. J Am Acad Dermatol 2009; 61:695-700. [PMID: 19344977 DOI: 10.1016/j.jaad.2009.01.039] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 01/25/2009] [Accepted: 01/25/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND It has been suggested that juvenile hyaline fibromatosis and infantile systemic hyalinosis represent different severities of the same disease. OBJECTIVE We sought to redefine these disorders clearly to establish a common inclusive terminology. PATIENTS The study included two children with early onset of similar pink papulonodular skin lesions and marked gingival hyperplasia. The first case was characterized by flexion contractures of the large joints, fractures, persistent diarrhea, recurrent chest infections, and retarded physical growth. The second patient had large swellings on the scalp and knees without systemic involvement. RESULTS Radiologic examination revealed fractures and osteolytic bone lesions in the first case, and soft tissue masses in the second case. Laboratory tests showed anemia in both cases, and hypogammaglobulinemia, hypoalbuminemia, and electrolyte imbalance in the first case. Histopathological and ultrastructural evaluation demonstrated hyalinized fibrous tissue in the dermis in both cases. LIMITATIONS Genetic studies were unavailable. CONCLUSION Juvenile hyaline fibromatosis and infantile systemic hyalinosis share many common features that strongly support consideration of these conditions as different expressions of the same disorder. We propose a common term, "hyaline fibromatosis syndrome," which can be divided into mild, moderate, and severe subtypes.
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Affiliation(s)
- Ahmad Nofal
- Dermatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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Infantile systemic hyalinosis presenting as intractable infantile diarrhea. Eur J Pediatr 2009; 168:363-5. [PMID: 18563441 DOI: 10.1007/s00431-008-0760-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Accepted: 05/06/2008] [Indexed: 10/21/2022]
Abstract
Infantile systemic hyalinosis is an autosomal recessive disease characterized by severe progressive flexion contractures, multiple recurring subcutaneous tumours, and gingival hypertrophy. It is caused by mutations in the gene encoding capillary morphogenesis protein-2 (CMG2). Here we report a Saudi infant with infantile systemic hyalinosis who presented with intractable diarrhea, and we review the literature emphasizing recent developments in the molecular genetics of this disease.
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Stojkovic-Filipovic J, Gajic-Veljic M, Ivanovski P, Nikolic M. Thick skin, nodules, and immobility in an infant. Infantile systemic hyalinosis. Pediatr Dermatol 2008; 25:557-8. [PMID: 18950399 DOI: 10.1111/j.1525-1470.2008.00764.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Infantile systemic hyalinosis: Case report and review of the literature. J Am Acad Dermatol 2008; 58:303-7. [PMID: 18222328 DOI: 10.1016/j.jaad.2007.06.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 06/14/2007] [Accepted: 06/17/2007] [Indexed: 11/23/2022]
Abstract
Infantile systemic hyalinosis (ISH) is a rare, progressive autosomal recessive disease, which is usually fatal by the age of 2 years. Clinical onset typically occurs within the first few weeks of life. The disease is characterized by joint contractures, osteopenia, failure to thrive, gingival hypertrophy, diarrhea, protein-losing enteropathy, and frequent infections. Dermatologic manifestations include thickened skin, hyperpigmentation, perianal nodules, and facial papules. Histopathology shows hyaline deposits in the dermis and visceral organs. We describe a patient with ISH confirmed by clinical and histopathologic findings, as well as DNA sequence analysis, which revealed a novel homozygous T118K mutation in the CMG2 gene.
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Shieh JTC, Swidler P, Martignetti JA, Ramirez MCM, Balboni I, Kaplan J, Kennedy J, Abdul-Rahman O, Enns GM, Sandborg C, Slavotinek A, Hoyme HE. Systemic hyalinosis: a distinctive early childhood-onset disorder characterized by mutations in the anthrax toxin receptor 2 gene (ANTRX2). Pediatrics 2006; 118:e1485-92. [PMID: 17043134 DOI: 10.1542/peds.2006-0824] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We sought to further characterize the phenotype and facilitate clinical recognition of systemic hyalinosis in children who present with chronic pain and progressive contractures in early childhood. PATIENTS AND METHODS We report on 3 children who presented in infancy with symptoms and signs that initially were not recognized to be those of systemic hyalinosis. Although the children were evaluated for a variety of problems, including lysosomal storage disorders and nonaccidental trauma, all eventually underwent genetic analysis of the anthrax toxin receptor 2 gene (ANTRX2) and were diagnosed as having systemic hyalinosis. RESULTS We describe the recognizable but variable clinical phenotype of systemic hyalinosis and associated mutations in ANTRX2. Affected individuals presented in early infancy with severe pain and progressive contractures. Initial diagnostic evaluations were unrevealing; however, hyperpigmented skin over bony prominences, skin nodules, and fleshy perianal masses suggested a diagnosis of systemic hyalinosis. ANTRX2 analysis confirmed the diagnosis in each case. Although 2 of the children died in infancy as a result of complications of chronic diarrhea, the third child has survived into midchildhood. These data suggest that some ANTRX2 mutations, such as that identified in the long-term survivor, may be associated with a less severe course of disease. CONCLUSIONS Although some aspects of systemic hyalinosis may resemble lysosomal storage disorders, the clinical features of systemic hyalinosis are distinctive, and detection of an ANTRX2 mutation can confirm the diagnosis. Early recognition of affected individuals should allow for aggressive pain control and expectant management of the multiple associated problems, including gastrointestinal dysfunction.
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Affiliation(s)
- Joseph T C Shieh
- Division of Medical Genetics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305-5208, USA
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Muniz ML, Lobo AZC, Machado MCDMR, Valente NYS, Kim CA, Lourenço SV, Nico MMS. Exuberant juvenile hyaline fibromatosis in two patients. Pediatr Dermatol 2006; 23:458-64. [PMID: 17014642 DOI: 10.1111/j.1525-1470.2006.00283.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Juvenile hyaline fibromatosis and infantile systemic hyalinosis are rare autosomal recessive disorders of infancy and early childhood that are histologically characterized by deposition of hyaline material. The main clinical features are papulo-nodular skin lesions, gingival hypertrophy, joint contractures, and bone abnormalities. However, infantile systemic hyalinosis has a more severe clinical presentation, including visceral involvement and premature death. Very recently, genetic studies identified mutations in the same gene in patients with both conditions, strongly suggesting that they belong to the same disease spectrum. We report two new nonrelated patients who met the criteria for the diagnosis of juvenile hyaline fibromatosis/infantile systemic hyalinosis. Clinical, histopathologic, immunohistochemical, and ultrastructural findings are presented, as well as an extensive review of the literature. Recent information regarding pathogenesis and treatment is discussed.
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Affiliation(s)
- Mariela Leão Muniz
- Department of Dermatology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
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