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Hübner S, Schwieger-Briel A, Technau-Hafsi K, Danescu S, Baican A, Theiler M, Weibel L, Has C. Phänotypisches und genetisches Spektrum von Incontinentia pigmenti – eine große Fallserie. J Dtsch Dermatol Ges 2022; 20:35-44. [PMID: 35040575 DOI: 10.1111/ddg.14638_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
HINTERGRUND Incontinentia pigmenti ist eine seltene X-chromosomal dominant vererbte Systemerkrankung, die vor allem die Haut, aber auch andere neuroektodermale Gewebe wie Zähne, Haare, Augen und das zentrale Nervensystem betrifft. PATIENTEN UND METHODIK Diese multizentrische Fallserienstudie wurde an drei europäischen Hautkliniken durchgeführt und umfasste 30 Patienten mit Incontinentia pigmenti. Zwanzig Patienten wurden klinisch und genetisch untersucht, weitere zehn nur genetisch. ERGEBNISSE Die Studie umfasste 28 Frauen und zwei Männer mit einem medianen Alter von drei Jahren. Kutane Manifestationen zeigten sich bei allen 20 Patienten mit klinischen Daten. Stadium I wurde in 90 % dieser Patienten beobachtet. Stadium IV wurde bereits im Alter von einem Jahr beobachtet. Zahn- (81 %), Haar- (78 %) und neurologische Anomalien (53 %) waren häufiger als in bisherigen Berichten. Vierzehn Hautbiopsien zeigten typische Merkmale des entsprechenden Stadiums. Genetische Tests wurden bei 24 Patienten durchgeführt, von denen 14 die häufige Exon 4-10-Deletion und sieben andere pathogene Varianten aufwiesen, darunter drei unveröffentlichte Mutationen. In drei weiteren Fällen wurden keine genetischen Veränderungen gefunden. SCHLUSSFOLGERUNGEN In dieser Studie reichte der Phänotyp von lediglich subtil ausgeprägter Hautbeteiligung bis hin zu schweren Multisystemerkrankungen. Die extrakutane Beteiligung sollte zum Zeitpunkt der Diagnose und in regelmäßigen Abständen evaluiert werden, da sich einige Manifestationen erst mit der Zeit entwickeln. SUMMARY Background and objectives Incontinentia pigmenti is a rare X-linked dominantly inherited systemic disease affecting primarily the skin but also other neuroectodermal tissues such as teeth, hair, eyes, and the central nervous system. Patients and methods This multicenter case series study was conducted at three European departments of Dermatology including 30 patients with incontinentia pigmenti. Twenty patients were evaluated clinically and genetically, another ten only genetically. Results The study included 28 females and two males with a median age of three years. Cutaneous manifestations were present in all 20 patients with clinical data. Stage I was observed in 90 % of those patients. Stage IV was observed as early as one year of age. Dental (81 %), hair (78 %) and neurological anomalies (53 %) were more frequent than previously reported. Fourteen skin biopsies showed typical features of the corresponding stage. Genetic testing of 24 patients revealed the common exon 4-10 deletion in 14 cases and seven other pathogenic variants, including three unpublished mutations. In another three cases, no genetic alterations were found. Conclusions In this study, the phenotype ranged from only subtle cutaneous involvement to severe multisystemic disorders. Extracutaneous involvement should be evaluated at the time of diagnosis and in regular intervals, as some manifestations may develop over time.
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Affiliation(s)
- Stefanie Hübner
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Deutschland
| | | | | | - Sorina Danescu
- Klinik für Dermatologie, Iuliu Haţieganu Universität für Medizin und Pharmazie, Cluj-Napoca, Rumänien
| | - Adrian Baican
- Klinik für Dermatologie, Iuliu Haţieganu Universität für Medizin und Pharmazie, Cluj-Napoca, Rumänien
| | - Martin Theiler
- Pädiatrische Dermatologie, Universitäts-Kinderspital Zürich, Schweiz
| | - Lisa Weibel
- Pädiatrische Dermatologie, Universitäts-Kinderspital Zürich, Schweiz
| | - Cristina Has
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Deutschland.,Europäisches Referenznetzwerk (ERN) für seltene und nicht-diagnostizierte Hauterkrankungen
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2
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Hübner S, Schwieger-Briel A, Technau-Hafsi K, Danescu S, Baican A, Theiler M, Weibel L, Has C. Phenotypic and genetic spectrum of incontinentia pigmenti - a large case series. J Dtsch Dermatol Ges 2021; 20:35-43. [PMID: 34904373 DOI: 10.1111/ddg.14638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Incontinentia pigmenti is a rare X-linked dominantly inherited systemic disease affecting primarily the skin but also other neuroectodermal tissues such as teeth, hair, eyes, and the central nervous system. PATIENTS AND METHODS This multicenter case series study was conducted at three European departments of Dermatology including 30 patients with incontinentia pigmenti. Twenty patients were evaluated clinically and genetically, another ten only genetically. RESULTS The study included 28 females and two males with a median age of three years. Cutaneous manifestations were present in all 20 patients with clinical data. Stage I was observed in 90 % of those patients. Stage IV was observed as early as one year of age. Dental (81 %), hair (78 %) and neurological anomalies (53 %) were more frequent than previously reported. Fourteen skin biopsies showed typical features of the corresponding stage. Genetic testing of 24 patients revealed the common exon 4-10 deletion in 14 cases and seven other pathogenic variants, including three unpublished mutations. In another three cases, no genetic alterations were found. CONCLUSIONS In this study, the phenotype ranged from only subtle cutaneous involvement to severe multisystemic disorders. Extracutaneous involvement should be evaluated at the time of diagnosis and in regular intervals, as some manifestations may develop over time.
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Affiliation(s)
- Stefanie Hübner
- Department of Dermatology, Medical Center-University of Freiburg, Germany
| | - Agnes Schwieger-Briel
- Pediatric Skin Center, Dermatology Department, University Children's Hospital, Zurich, Switzerland
| | | | - Sorina Danescu
- Department of Dermatology, Iuliu Hat˛ieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adrian Baican
- Department of Dermatology, Iuliu Hat˛ieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Martin Theiler
- Pediatric Skin Center, Dermatology Department, University Children's Hospital, Zurich, Switzerland
| | - Lisa Weibel
- Pediatric Skin Center, Dermatology Department, University Children's Hospital, Zurich, Switzerland
| | - Cristina Has
- Department of Dermatology, Medical Center-University of Freiburg, Germany.,European Reference Network (ERN) on Rare and Undiagnosed Skin Disorders
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Chimbili M, Shanmukhappa A, Budamakuntla L, Kanathur S. A rare association of incontinentia pigmenti with congenital heart disease in a newborn. INDIAN JOURNAL OF PAEDIATRIC DERMATOLOGY 2021. [DOI: 10.4103/ijpd.ijpd_34_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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4
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Mizuno M, Aso K, Tsuzuki Y, Kitazawa T, Migita O, Hokuto I, Yamamoto H. A successful treatment of tadalafil in incontinentia pigmenti with pulmonary hypertension. Eur J Med Genet 2019; 63:103764. [PMID: 31518693 DOI: 10.1016/j.ejmg.2019.103764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 09/09/2019] [Indexed: 11/19/2022]
Abstract
We describe a female infant with incontinentia pigmenti complicated by severe pulmonary arterial hypertension that was markedly improved by tadalafil administration. The infant was referred to our institution because of neonatal seizures and generalized skin rash at the age of 1 day. She was diagnosed with incontinentia pigmenti on skin biopsy findings. In addition to incontinentia pigmenti, she had pulmonary arterial hypertension without structural heart disease. The pulmonary hypertension rapidly worsened at the age of 2 months and was confirmed by cardiac catheterization. The pulmonary artery pressure was equal to systemic pressure but it decreased in response to nitric oxide inhalation. We, therefore, initiated treatment with tadalafil of 1 mg/kg/day. The follow-up cardiac catheterization performed at 9 months revealed dramatic improvement in the pulmonary artery pressure. An IKBKG mutation with deletion of exons 4-10 was detected in the blood of both the patient and her mother. Our experience indicates that tadalafil may be beneficial in treating pulmonary arterial hypertension associated with incontinentia pigmenti.
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Affiliation(s)
- Masanori Mizuno
- Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - Kentaro Aso
- Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshimitsu Tsuzuki
- Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomoko Kitazawa
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ohsuke Migita
- Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Isamu Hokuto
- Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hitoshi Yamamoto
- Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
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5
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Atallah V, Meot M, Kossorotoff M, Galmiche-Rolland L, Lardeux C, Neven B, Bodemer C, Bonnet D. A case of reversible pulmonary arterial hypertension associated with incontinentia pigmenti. Pulm Circ 2018; 8:2045894018793983. [PMID: 30036148 PMCID: PMC6131310 DOI: 10.1177/2045894018793983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Incontinentia pigmenti (IP) is a multisystemic disorder in which pulmonary arterial hypertension (PAH) is a severe and rarely reported association. The prognosis has been poor in reported cases. In our patient, IP was diagnosed during the neonatal period with a combination of cutaneous, ophthalmic, and neurological symptoms. The infant experienced severe collapse with bradycardia during general anesthesia to treat retinal telangiectasia. Echocardiography after resuscitation revealed suprasystemic pulmonary hypertension (PH). Right heart catheterization (RHC) confirmed precapillary PAH not responding to acute vasodilatation test. Lung biopsy was performed to exclude alveolo-capillary dysplasia. Upfront triple therapy with endothelin receptor antagonist, PDE5 inhibitors, and prostacyclin was started. Due to a potential inflammatory mechanism of this acute PAH in the setting of IP, TNF-alpha blockers and steroids were associated. The evolution was favorable with progressive normalization of the pulmonary artery pressure confirmed by RHC after six months. Doses of PAH drugs were tapered down, and finally all PAH treatments could be stopped after 18 months. Subsequent controls including physical exams and echocardiograms did not show signs of PH. This unusual reversible case of pediatric PAH without associated congenital heart disease or portal hypertension highlights the potential reversibility of pediatric PH when an inflammatory mechanism can be suspected. This is the first reported case of non-fatal isolated PAH associated with IP.
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Affiliation(s)
- Veronique Atallah
- 1 Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France
| | - Mathilde Meot
- 1 Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France
| | - Manoelle Kossorotoff
- 2 Department of Pediatric Neurology, Necker Enfants Malades Hospital, Paris, France
| | | | - Claude Lardeux
- 1 Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France
| | - Benedicte Neven
- 4 Department of Immunology, Necker Enfants Malades Hospital, Paris, France
| | - Christine Bodemer
- 5 Department of Dermatology, National Reference Centre for Genodermatoses (MAGEC), Necker Enfants malades Hospital, Paris, France.,6 UMR 1163, Imagine Institute, University René Descartes, PRES Sorbonne Paris, France
| | - Damien Bonnet
- 1 Department of Pediatric Cardiology, Necker Enfants Malades Hospital, Paris, France.,6 UMR 1163, Imagine Institute, University René Descartes, PRES Sorbonne Paris, France
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6
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Onnis G, Diociaiuti A, Zangari P, D'Argenio P, Cancrini C, Iughetti L, El Hachem M. Cardiopulmonary anomalies in incontinentia pigmenti patients. Int J Dermatol 2017; 57:40-45. [PMID: 29197078 DOI: 10.1111/ijd.13835] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/01/2017] [Accepted: 10/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Incontinentia pigmenti (IP) is a rare inherited genodermatosis that usually involves the skin, and also teeth, oral cavity, central nervous system, eyes, blood with eosinophilia, and rarely skeletal system, breast, heart, and lungs. Skin lesions usually appear early, at birth or within the first 2 weeks of life, with four different phases tending to follow Blaschko lines that may overlap. CASE REPORT We report a rare case of a neonate with transient reversible pulmonary hypertension that presented at day 9 of life. She manifested increasing dyspnea and deterioration of respiratory dynamics with a serious pulmonary hypertension without a primary pulmonary disease. Hence, oxygen therapy at high flows and nitric oxide have been administered with an initial response, but, subsequently, because of the worsening of the respiratory activity, she underwent sildenafil and bosentan treatment with respiratory dynamics improvement and progressive decrease of the pulmonary pressures. CONCLUSION In literature only a few cases of cardiopulmonary anomalies in IP have been described with different outcomes, and these rare complications are probably underestimated by physicians. We could suppose that microangiopathic damages may have a critical role in endothelial alterations, and these processes are probably shared by multiple organs involved in IP and rarely by lungs and heart.
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Affiliation(s)
- Giuliana Onnis
- Dermatology Unit, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy
| | - Andrea Diociaiuti
- Dermatology Unit, Academic Department of Pediatrics, Children's Hospital Bambino Gesù -IRCCS, Rome, Italy
| | - Paola Zangari
- Unit of Immune and Infectious Diseases, Academic Department of Pediatrics, Children's Hospital Bambino Gesù, Rome, Italy
| | - Patrizia D'Argenio
- Unit of Immune and Infectious Diseases, Academic Department of Pediatrics, Children's Hospital Bambino Gesù, Rome, Italy
| | - Caterina Cancrini
- Unit of Immune and Infectious Diseases, Academic Department of Pediatrics, Children's Hospital Bambino Gesù, Rome, Italy
| | - Lorenzo Iughetti
- Department of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - May El Hachem
- Dermatology Unit, Academic Department of Pediatrics, Children's Hospital Bambino Gesù -IRCCS, Rome, Italy
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7
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Gianfaldoni S, Tchernev G, Wollina U, Lotti T. Incontinentia Pigmenti: A Case Report of a Complex Systemic Disease. Open Access Maced J Med Sci 2017; 5:501-505. [PMID: 28785344 PMCID: PMC5535669 DOI: 10.3889/oamjms.2017.128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 04/22/2017] [Accepted: 04/23/2017] [Indexed: 12/01/2022] Open
Abstract
Incontinentia Pigmenti is an uncommon X-linked genodermatosis, caused by mutations in the NEMO gene. It is a systemic disease that involves tissue of ectodermic and mesodermic origin, including cutaneous tissue, teeth, eyes and the central nervous system, amongst other organs. The Authors report a rare case of Incontinentia Pigmenti in a female newborn.
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Affiliation(s)
- Serena Gianfaldoni
- University G. Marconi of Rome, Dermatology and Venereology, Rome 00192, Italy
| | - Georgi Tchernev
- Medical Institute of the Ministry of Interior, Dermatology, Venereology and Dermatologic Surgery; Onkoderma, Private Clinic for Dermatologic Surgery, Dermatology and Surgery, Sofia 1407, Bulgaria
| | - Uwe Wollina
- Krankenhaus Dresden-Friedrichstadt, Department of Dermatology and Venereology, Dresden, Sachsen, Germany
| | - Torello Lotti
- Universitario di Ruolo, Dipartimento di Scienze Dermatologiche, Università degli Studi di Firenze, Facoltà di Medicina e Chirurgia, Dermatology, Via Vittoria Colonna 11, Rome 00186, Italy
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8
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Alshenqiti A, Nashabat M, AlGhoraibi H, Tamimi O, Alfadhel M. Pulmonary hypertension and vasculopathy in incontinentia pigmenti: a case report. Ther Clin Risk Manag 2017; 13:629-634. [PMID: 28533687 PMCID: PMC5431708 DOI: 10.2147/tcrm.s134705] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Incontinentia pigmenti (IP; Bloch-Sulzberger syndrome) is a rare, genetic syndrome inherited as an X-linked dominant trait. It primarily affects female infants and is lethal in the majority of males during fetal life. The clinical findings include skin lesions, developmental defects, and defects of the eyes, teeth, skeletal system, and central nervous system. Cardiovascular complications of this disease in general, and pulmonary hypertension in particular, are extremely rare. This report describes the case of a 3-year-old girl with IP complicated by pulmonary arterial hypertension. Extensive cardiology workup done to the patient indicates underlying vasculopathy. This report sheds light on the relationship between IP and pulmonary hypertension, reviews the previously reported cases, and compares them with the reported case.
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Affiliation(s)
- Abduljabbar Alshenqiti
- Division of Genetics, Department of Pediatrics, King Abdullah International Medical Research Centre, King Saud bin Abdulaziz Uiversity for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Marwan Nashabat
- Division of Genetics, Department of Pediatrics, King Abdullah International Medical Research Centre, King Saud bin Abdulaziz Uiversity for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Hissah AlGhoraibi
- Division of Genetics, Department of Pediatrics, King Abdullah International Medical Research Centre, King Saud bin Abdulaziz Uiversity for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Omar Tamimi
- Department of Cardiology, King Abdullah International Medical Research Centre, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs (NGHA), Riyadh, Saudi Arabia
| | - Majid Alfadhel
- Division of Genetics, Department of Pediatrics, King Abdullah International Medical Research Centre, King Saud bin Abdulaziz Uiversity for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
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9
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Yasuda K, Minami N, Yoshikawa Y, Taketani T, Fukuda S, Yamaguchi S. Fatal pulmonary arterial hypertension in an infant girl with incontinentia pigmenti. Pediatr Int 2016; 58:394-396. [PMID: 27173419 DOI: 10.1111/ped.12831] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 11/30/2022]
Abstract
We report the case of an infant girl with incontinentia pigmenti (IP) complicated by fatal pulmonary arterial hypertension (PAH). She was diagnosed with IP, based on the presence of specific skin lesions, neonatal seizures, hypereosinophilia and a maternal family history of IP. At the age of 2 months, she was diagnosed with PAH on systolic heart murmur due to tricuspid valve regurgitation. Despite several treatments for PAH but not including epoprostenol, severe PAH persisted and she died of pulmonary hypertensive crisis at the age of 5 months. On postmortem histopathology the pulmonary artery had severe intimal thickening, with occlusion or stenosis of the vascular lumen of the small pulmonary arteries as well as partial plexiform lesions, all of which were compatible with PAH. Modulation of nuclear factor-κB signaling may be involved in the development of PAH in IP.
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Affiliation(s)
- Kenji Yasuda
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo City, Shimane, Japan
| | - Noriaki Minami
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo City, Shimane, Japan
| | - Yoko Yoshikawa
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo City, Shimane, Japan
| | - Takeshi Taketani
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo City, Shimane, Japan.,Division of Blood Transfusion, Shimane University Hospital, Izumo City, Shamane, Japan
| | - Seiji Fukuda
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo City, Shimane, Japan
| | - Seiji Yamaguchi
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo City, Shimane, Japan
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Zamora-Chávez A, Escobar-Sánchez A, Sadowinski-Pine S, Saucedo-Ramírez OJ, Delgado-Barrera P, Enríquez-Quiñones CG. [Incontinentia pigmenti with defect in cellular immunity]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2015; 72:325-332. [PMID: 29421531 DOI: 10.1016/j.bmhimx.2015.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 07/28/2015] [Accepted: 08/13/2015] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Incontinentia pigmenti is a rare, X-linked genetic disease and affects all ectoderm-derived tissues such as skin, appendages, eyes, teeth and central nervous system as well as disorders of varying degree of cellular immunity characterized by decreasing melanin in the epidermis and increase in the dermis. When the condition occurs in males, it is lethal. CASE REPORT We present the case of a 2-month-old infant with severe incontinentia pigmenti confirmed by histological examination of skin biopsy. The condition evolved with severe neurological disorders and seizures along with severe cellular immune deficiency, which affected the development of severe infections and caused the death of the patient. CONCLUSIONS The importance of early clinical diagnosis is highlighted along with the importance of multidisciplinary management of neurological disorders and infectious complications.
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Affiliation(s)
- Antonio Zamora-Chávez
- Departamento de Medicina Interna, Hospital Infantil de México Federico Gómez, México D.F., México.
| | | | | | - Omar Josué Saucedo-Ramírez
- Departamento de Alergia e Inmunología Clínica, Hospital Infantil de México Federico Gómez, México D.F., México
| | - Palmira Delgado-Barrera
- Departamento de Alergia e Inmunología Clínica, Hospital Infantil de México Federico Gómez, México D.F., México
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11
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Poziomczyk CS, Recuero JK, Bringhenti L, Maria FDS, Campos CW, Travi GM, Freitas AM, Maahs MAP, Zen PRG, Fiegenbaum M, Almeida STD, Bonamigo RR, Bau AEK. Incontinentia pigmenti. An Bras Dermatol 2014; 89:26-36. [PMID: 24626645 PMCID: PMC3938351 DOI: 10.1590/abd1806-4841.20142584] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 04/09/2013] [Indexed: 12/25/2022] Open
Abstract
Incontinentia pigmenti is a rare genodermatosis in which the skin involvement occurs
in all patients. Additionally, other ectodermal tissues may be affected, such as the
central nervous system, eyes, hair, nails and teeth. The disease has a X-linked
dominant inheritance pattern and is usually lethal to male fetuses. The
dermatological findings occur in four successive phases, following the lines of
Blaschko: First phase - vesicles on an erythematous base; second phase - verrucous
hyperkeratotic lesions; third phase - hyperchromic spots and fourth phase -
hypochromic atrophic lesions.
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Affiliation(s)
- Cláudia Schermann Poziomczyk
- Porto Alegre Health Sciences Federal University, Pathology Post-graduation Program, Porto AlegreRS, Brazil, MD, Dermatologist - MSc (in course) at the Pathology Post-graduation Program at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Júlia Kanaan Recuero
- Porto Alegre Health Sciences Federal University, Porto AlegreRS, Brazil, Medical Student at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Luana Bringhenti
- Porto Alegre Health Sciences Federal University, Porto AlegreRS, Brazil, Medical Student at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Fernanda Diffini Santa Maria
- Porto Alegre Health Sciences Federal University, Pathology Post-graduation Program, Porto AlegreRS, Brazil, DDS - MSc (in course) at the Pathology Post-graduation Program at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Carolina Wiltgen Campos
- Santa Casa de Misericórdia de Porto Alegre, Ophthalmology Program, Porto AlegreRS, Brazil, MD - Resident in the Ophthalmology Program at Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brazil
| | - Giovanni Marcos Travi
- Santa Casa de Misericórdia de Porto Alegre, Porto AlegreRS, Brazil, MD - Ophthalmologist with specialization in Pediatric Ophthalmology and Strabismus Licensed physician at Santa Casa de Misericórdia de Porto Alegre- Porto Alegre (RS), Brazil
| | - André Moraes Freitas
- Santa Casa de Misericórdia de Porto Alegre Ophthalmology Service, Ophthalmology Service, Retina Sector, Porto AlegreRS, Brazil, MD - Ophthalmologist - Chief of the Retina Sector at Santa Casa de Misericórdia de Porto Alegre Ophthalmology Service - Porto Alegre (RS), Brazil
| | - Marcia Angelica Peter Maahs
- Rio Grande do Sul Federal University, Porto AlegreRS, Brazil, DDS - Specialist in Orthodontics and Facial Orthopedics at Rio Grande do Sul Federal University (UFRGS). PhD in Dentistry at Rio Grande do Sul Pontifical Catholic University (PUCRS) - Substitute Professor of the Discipline of Orthodontics Applied to Speech Therapy at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Paulo Ricardo Gazzola Zen
- Porto Alegre Health Sciences Federal University, Pathology Post-graduation Program, Porto AlegreRS, Brazil, MD, PhD at the Pathology Post-graduation Program at Porto Alegre Health Sciences Federal University (UFCSPA) - Adjunct Professor of Genetics at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Marilu Fiegenbaum
- Porto Alegre Health Sciences Federal University, Basic Health Sciences Department, Porto AlegreRS, Brazil, Pharm. D. - PhD in Genetics and Molecular Biology at Rio Grande do Sul Federal University (UFRGS) - Adjunct Professor at the Basic Health Sciences Department at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Sheila Tamanini de Almeida
- Porto Alegre Health Sciences Federal University, Speech Therapy Department, Porto AlegreRS, Brazil, Speech-Language Pathologist (SLPs) - Specialist in Orofacial Motricity and Dysphagia. MSc in Health Sciences - Assistant Professor at the Speech Therapy Department at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Renan Rangel Bonamigo
- Porto Alegre Health Sciences Federal University, Pathology Postgraduation Program, Porto AlegreRS, Brazil, MD - PhD in Health Sciences at Rio Grande do Sul Federal University (UFRGS) - Head Professor of Dermatology and Professor of the Pathology Postgraduation Program at Porto Alegre Health Sciences Federal University (UFCSPA) - Porto Alegre (RS), Brazil
| | - Ana Elisa Kiszewski Bau
- Porto Alegre Health Sciences Federal University, Porto AlegreRS, Brazil, MD - PhD in Pathology at Porto Alegre Health Sciences Federal University (UFCSPA)- Adjunct Professor of Dermatology at Porto Alegre Health Sciences Federal University (UFCSPA). Pediatric Dermatologist at Santo Antonio Children's Hospital and at Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brazil
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Kim TH, Choi YJ, Park HK, Kim CR, Lee HJ. A Case of Incontinentia Pigmenti with Multiple Brain Infarction. NEONATAL MEDICINE 2013. [DOI: 10.5385/nm.2013.20.2.228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Tae Hee Kim
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea
| | - Young Jin Choi
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyun-Kyung Park
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea
| | - Chang-Ryul Kim
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyun Ju Lee
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea
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Meuwissen ME, Mancini GM. Neurological findings in incontinentia pigmenti; a review. Eur J Med Genet 2012; 55:323-31. [DOI: 10.1016/j.ejmg.2012.04.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 04/22/2012] [Indexed: 10/28/2022]
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Kaczala GW, Messer MA, Poskitt KJ, Prendiville JS, Gardiner J, Senger C. Therapy resistant neonatal seizures, linear vesicular rash, and unusually early neuroradiological changes: incontinentia pigmenti: a case report, literature review and insight into pathogenesis. Eur J Pediatr 2008; 167:979-83. [PMID: 17938957 DOI: 10.1007/s00431-007-0618-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Revised: 09/17/2007] [Accepted: 09/21/2007] [Indexed: 12/01/2022]
Abstract
CASE PRESENTATION A substance abusing G2P1 mother spontaneously delivered at term an appropriate for gestational age girl. Neonatal seizures appeared at 21 hours and empiric anticonvulsive and antimicrobial treatment was started. At 25 hours, first vesicles appeared. While routine evaluations remained normal, a head CT revealed multifocal ischemic injuries, and a later MRI showed multifocal petechiae and diffusion abnormalities in the corticospinal tracts. The clinical diagnosis of incontinentia pigmenti (stage 1) was secured by histopathology. Follow-up at 13 months showed global developmental delay. DISCUSSION We discuss the unusually early bilateral, fronto-occipital corticomedullar ischemias (CT day 3). On the MR imaging (day 7) extensive symmetric cerebral corticomedullar destruction and diffusion sequences with corticospinal tracts abnormalities are seen, which then evolve (day 26) to extensive symmetric cerebral destruction. We review the literature, genetics, suspected pathophysiology and possible neonatal manifestation. CONCLUSION Incontinentia pigmenti is rare and, therefore, diagnosis is frequently delayed. Nevertheless, in the setting of therapy refractory seizures, excluded infections, and linear vesicular rash, a high index of suspicion is needed. This is the first report of simultaneous corticomedullar involvement as early as the third day of life.
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Affiliation(s)
- Gregor W Kaczala
- Department of Neonatology, Children's and Women's Health Center of British Columbia, Vancouver, BC, Canada.
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