Focus on the physical assessment of the infant with Stickler syndrome

Recognizable syndromes in the newborn period

Making the diagnosis of genetic syndromes in the neonatal period can be challenging, as limited information concerning growth and development is available. The pattern of dysmorphic features and malformations is, therefore, correspondingly more important in syndrome recognition. The authors provide specific examples of the differences in the presentation for selected syndromes between the newborn period and later childhood. The purpose is to describe the variation in presentation that can occur with chronologic age and to aid in the early diagnosis of these conditions.

Exome analysis of connective tissue dysplasia: death and rebirth of clinical genetics?

Exome results are reported for two patients with connective tissue dysplasia, one refining a clinical diagnosis of Ehlers-Danlos to Marfan syndrome, the other suggesting arthrogryposis derived from maternofetal Stickler syndrome. Patient 1 had mutations in transthyretin (TTR), fibrillin (FBN1), and a calcium channel (CACNA1A) gene suggesting diagnoses of transthyretin amyloidosis, Marfan syndrome, and familial hemiplegic migraines, respectively. Patient 2 presented with arthrogryposis that was correlated with his mother's habitus and arthritis once COL2A1 mutations suggestive of Stickler syndrome were defined. Although DNA results often defy prediction by the best of clinicians, these patients illustrate needs for ongoing clinical scholarship (e.g., to delineate guidelines for management of mutations like that for hyperekplexia in Patient 2) and for interpretation of polygenic change that is optimized by clinical genetic/syndromology experience (e.g., suggesting acetazolamide therapy for Patient 1 and explaining arthrogryposis in Patient 2).

A child with leukocoria

Leukocoria, meaning "white pupil," describes the clinical finding of a white pupillary reflex on examination. It may be discovered through an asymmetric red reflex using direct ophthalmoscopy, or it may be seen incidentally on flash photography. It results from an abnormality of the eyeball that interferes with the normal reflective process. We report a case of a 3-year-old boy who presents with leukocoria found to be caused by a retinoblastoma and discuss the differential diagnosis of this uncommon presentation to the pediatric emergency department.