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Lainingwala AC, Gajula S, Fatima U, Afroze S, Posani S, Moondra M, Mangukiya NP, Parmar MP, Venugopal V. A Unique Case of Harlequin Ichthyosis in the Tertiary Health Care System in a Rural Area. Cureus 2023; 15:e43342. [PMID: 37700957 PMCID: PMC10495033 DOI: 10.7759/cureus.43342] [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: 07/25/2023] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
Harlequin ichthyosis (HI) is a severe and rare genetic anomaly that affects skin development and leads to the formation of thick, diamond-shaped plates of keratinized skin. The adenosine triphosphate binding cassette A 12 (ABCA12) gene, which is essential for the transportation of lipids required for the skin's barrier function, has mutations that result in this condition. The affected individuals exhibit distinct clinical features, including thickened skin, deep cracks, and fissures, which can result in significant physical and functional impairments. HI is usually apparent at birth, with affected infants presenting with tight and rigid skin that restricts movement and normal growth. The condition is associated with various complications, including difficulty breathing, feeding difficulties, and increased susceptibility to infections. Due to the impaired skin barrier, affected individuals are also prone to dehydration and temperature dysregulation. In this case report, we present a unique case of ichthyosis in a nine-month-old child. Despite advances in medical care, HI remains a challenging condition with a high mortality rate, particularly in the neonatal period. However, with early detection, appropriate interventions, and an improved understanding of the underlying molecular mechanisms, there is hope for enhanced management and improved quality of life for individuals living with HI.
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Affiliation(s)
- Aashka C Lainingwala
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
| | - Sahini Gajula
- Internal Medicine, Gandhi Medical College and Hospital, Secunderabad, IND
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
| | - Umaima Fatima
- Internal Medicine, Shadan Institute of Medical Sciences, Teaching Hospital and Research Centre, Hyderabad, IND
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
| | - Sabah Afroze
- Internal Medicine, Shadan Institute of Medical Sciences, Teaching Hospital and Research Centre, Hyderabad, IND
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
| | - Sarojini Posani
- Internal Medicine, Sri Devaraj Urs Medical College, Kolar, IND
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
| | - Mudit Moondra
- Internal Medicine, Rabindranath Tagore Medical College, Udaipur, IND
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
| | - Nisarg P Mangukiya
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
| | - Mihirkumar P Parmar
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
| | - Vishal Venugopal
- Internal Medicine, Bhaarath Medical College & Hospital, Chennai, IND
- Internal Medicine, Gujarat Medical Education & Research Society Medical College, Vadnagar, Mehsana, IND
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Sun Q, Burgren NM, Cheraghlou S, Paller AS, Larralde M, Bercovitch L, Levinsohn J, Ren I, Hu RH, Zhou J, Zaki T, Fan R, Tian C, Saraceni C, Nelson-Williams CJ, Loring E, Craiglow BG, Milstone LM, Lifton RP, Boyden LM, Choate KA. The Genomic and Phenotypic Landscape of Ichthyosis: An Analysis of 1000 Kindreds. JAMA Dermatol 2021; 158:16-25. [PMID: 34851365 DOI: 10.1001/jamadermatol.2021.4242] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Ichthyoses are clinically and genetically heterogeneous disorders characterized by scaly skin. Despite decades of investigation identifying pathogenic variants in more than 50 genes, clear genotype-phenotype associations have been difficult to establish. Objective To expand the genotypic and phenotypic spectra of ichthyosis and delineate genotype-phenotype associations. Design, Setting, and Participants This cohort study recruited an international group of individuals with ichthyosis and describes characteristic and distinguishing features of common genotypes, including genotype-phenotype associations, during a 10-year period from June 2011 to July 2021. Participants of all ages, races, and ethnicities were included and were enrolled worldwide from referral centers and patient advocacy groups. A questionnaire to assess clinical manifestations was completed by those with a genetic diagnosis. Main Outcomes and Measures Genetic analysis of saliva or blood DNA, a phenotyping questionnaire, and standardized clinical photographs. Descriptive statistics, such as frequency counts, were used to describe the cases in the cohort. Fisher exact tests identified significant genotype-phenotype associations. Results Results were reported for 1000 unrelated individuals enrolled from around the world (mean [SD] age, 50.0 [34.0] years; 524 [52.4%] were female, 427 [42.7%] were male, and 49 [4.9%] were not classified); 75% were from the US, 12% from Latin America, 4% from Canada, 3% from Europe, 3% from Asia, 2% from Africa, 1% from the Middle East, and 1% from Australia and New Zealand. A total of 266 novel disease-associated variants in 32 genes were identified among 869 kindreds. Of these, 241 (91%) pathogenic variants were found through multiplex amplicon sequencing and 25 (9%) through exome sequencing. Among the 869 participants with a genetic diagnosis, 304 participants (35%) completed the phenotyping questionnaire. Analysis of clinical manifestations in these 304 individuals revealed that pruritus, hypohydrosis, skin pain, eye problems, skin odor, and skin infections were the most prevalent self-reported features. Genotype-phenotype association analysis revealed that the presence of a collodion membrane at birth (odds ratio [OR], 6.7; 95% CI, 3.0-16.7; P < .001), skin odor (OR, 2.8; 95% CI, 1.1-6.8; P = .02), hearing problems (OR, 2.9; 95% CI, 1.6-5.5; P < .001), eye problems (OR, 3.0; 95% CI, 1.5-6.0; P < .001), and alopecia (OR, 4.6; 95% CI, 2.4-9.0; P < .001) were significantly associated with TGM1 variants compared with other ichthyosis genotypes studied. Skin pain (OR, 6.8; 95% CI, 1.6-61.2; P = .002), odor (OR, 5.7; 95% CI, 2.0-19.7; P < .001), and infections (OR, 3.1; 95% CI, 1.4-7.7; P = .03) were significantly associated with KRT10 pathogenic variants compared with disease-associated variants in other genes that cause ichthyosis. Pathogenic variants were identified in 869 (86.9%) participants. Most of the remaining individuals had unique phenotypes, enabling further genetic discovery. Conclusions and Relevance This cohort study expands the genotypic and phenotypic spectrum of ichthyosis, establishing associations between clinical manifestations and genotypes. Collectively, the findings may help improve clinical assessment, assist with developing customized management plans, and improve clinical course prognostication.
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Affiliation(s)
- Qisi Sun
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Nareh M Burgren
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Shayan Cheraghlou
- The Ronald O. Perelman Department of Dermatology, Grossman School of Medicine, New York University, New York, New York
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Lionel Bercovitch
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Jonathan Levinsohn
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Ivy Ren
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Rong Hua Hu
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
| | - Jing Zhou
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
| | - Theodore Zaki
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Ryan Fan
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Charlie Tian
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Corey Saraceni
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Erin Loring
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
| | - Brittany G Craiglow
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Leonard M Milstone
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Richard P Lifton
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut.,Laboratory of Human Genetics and Genomics, The Rockefeller University, New York, New York
| | - Lynn M Boyden
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
| | - Keith A Choate
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut.,Department of Genetics, Yale University School of Medicine, New Haven, Connecticut.,Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
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Arias-Pérez RD, Gallego-Quintero S, Taborda NA, Restrepo JE, Zambrano-Cruz R, Tamayo-Agudelo W, Bermúdez P, Duque C, Arroyave I, Tejada-Moreno JA, Villegas-Lanau A, Mejía-García A, Zapata W, Hernandez JC, Cuartas-Montoya G. Ichthyosis: case report in a Colombian man with genetic alterations in ABCA12 and HRNR genes. BMC Med Genomics 2021; 14:140. [PMID: 34039366 PMCID: PMC8157432 DOI: 10.1186/s12920-021-00987-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Ichthyosis is a heterogeneous group of diseases caused by genetic disorders related to skin formation. They are characterized by generalized dry skin, scaling, hyperkeratosis and frequently associated with erythroderma. Among its different types, harlequin ichthyosis (HI) stands out due to its severity. HI is caused by mutations in the ABCA12 gene, which encodes essential proteins in epidermal lipid transport, and it helps maintain the homeostasis of the stratum corneum of the epidermis. However, due to the wide spectrum of genetic alterations that can cause ichthyosis, holistic medical care, and genetic studies are required to improve the diagnosis and outcomes of these diseases. Case presentation Here, we presented the case of a 19 years old male patient who was a premature infant and exhibited clinical features consistent with HI, including bright yellow hyperkeratotic plates with erythematous fissures that covered his entire body like a collodion baby. Currently, he exhibited erythroderma, photosensitivity, ectropion, auricular pavilion alterations, and musculoskeletal disorders, such as equinovarus feet, fingers, hands, and hypoplastic feet with contractures in flexion and marked difficulty in fine motor skills. In addition, he presented dyschromatopsia, Achilles reflex hyporeflexia, slight speech, dental alteration and deficient cognitive performance. After the genetic sequencing, variants were found in ABCA12 and HRNR which are related to several skin diseases, including ichthyosis. Conclusions Although in clinical practice, ichthyosis is a common entity, a severe type of ichthyosis is presented, highlighting the importance of appropriate genetic diagnosis, given the broad spectrum of genetic alterations with similar phenotypic and clinical characteristics. These pathologies must be known to guarantee initial support measures to prevent complications and offer multidisciplinary management to those patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-021-00987-y.
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Affiliation(s)
- Ruben D Arias-Pérez
- Grupo de Investigaciones Biomédicas Uniremington, Programa de Medicina, Facultad de Ciencias de La Salud, Corporación Universitaria Remington, Medellín, Colombia
| | - Salomón Gallego-Quintero
- Grupo de Investigaciones Biomédicas Uniremington, Programa de Medicina, Facultad de Ciencias de La Salud, Corporación Universitaria Remington, Medellín, Colombia
| | - Natalia A Taborda
- Grupo de Investigaciones Biomédicas Uniremington, Programa de Medicina, Facultad de Ciencias de La Salud, Corporación Universitaria Remington, Medellín, Colombia
| | - Jorge E Restrepo
- Grupo OBSERVATOS, Facultad de Educación Y Ciencias Sociales, Tecnológico de Antioquia -Institución Universitaria, Medellín, Colombia
| | - Renato Zambrano-Cruz
- Grupo Neurociencia Y Cognición, Facultad de Psicología, Universidad Cooperativa de Colombia, Medellín, Colombia
| | - William Tamayo-Agudelo
- Grupo Neurociencia Y Cognición, Facultad de Psicología, Universidad Cooperativa de Colombia, Medellín, Colombia
| | - Patricia Bermúdez
- Grupo GIOM, Facultad de Odontología, Universidad Cooperativa de Colombia, Medellín, Colombia
| | - Constanza Duque
- Grupo GIOM, Facultad de Odontología, Universidad Cooperativa de Colombia, Medellín, Colombia
| | - Ismael Arroyave
- Grupo GIOM, Facultad de Odontología, Universidad Cooperativa de Colombia, Medellín, Colombia
| | - Johanna A Tejada-Moreno
- Grupo de Genética Molecular (GENMOL), Facultad de Ciencias Exactas y Naturales (FCEN), Universidad de Antioquia UdeA, Medellín, Colombia
| | - Andrés Villegas-Lanau
- Grupo de Genética Molecular (GENMOL), Facultad de Ciencias Exactas y Naturales (FCEN), Universidad de Antioquia UdeA, Medellín, Colombia
| | - Alejandro Mejía-García
- Grupo de Genética Molecular (GENMOL), Facultad de Ciencias Exactas y Naturales (FCEN), Universidad de Antioquia UdeA, Medellín, Colombia
| | - Wildeman Zapata
- Infettare, Facultad de Medicina, Universidad Cooperativa de Colombia, Medellín, Colombia
| | - Juan C Hernandez
- Infettare, Facultad de Medicina, Universidad Cooperativa de Colombia, Medellín, Colombia.
| | - Gina Cuartas-Montoya
- Grupo Neurociencia Y Cognición, Facultad de Psicología, Universidad Cooperativa de Colombia, Medellín, Colombia
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Liu J, Zhang X, Wang W, Lan X, Dong M, Yan K, Lei Y, Chen P, Yang M, Shan Q, Jin C. Case Report: Prenatal Diagnosis of a Fetus With Harlequin Ichthyosis Identifies Novel Compound Heterozygous Variants: A Case Report. Front Genet 2021; 11:608196. [PMID: 33510771 PMCID: PMC7835937 DOI: 10.3389/fgene.2020.608196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/14/2020] [Indexed: 11/27/2022] Open
Abstract
Background Harlequin ichthyosis (HI) is the most severe form of the keratinizing disorders, and it is characterized by whole-body hard stratum corneum. ABCA12 has been identified as the major disease-causing gene of HI. Methods A case of HI was prenatally diagnosed by ultrasonography and genetic tests. The fetus had been found with dentofacial deformity and profound thickening of the palm and plantar soft tissues. Chromosomal microarray analysis (CMA) and whole exome sequencing (WES) were then performed on the amniotic fluid to identify germline pathogenic variants for the fetus. Candidate variants were verified by Sanger sequencing. Results Compound heterozygous frameshift variants (p.Q719QfsX21; p.F2286LfsX6) of ABCA12 were identified for the fetus, suggesting the former variants were maternally inherited and the latter paternally inherited. The fetus was terminated. Conclusion A prenatal molecular diagnosis is an important approach for the prevention of HI. In the study, we provided a successful case of genetic counseling for a family with an HI baby.
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Affiliation(s)
- Jiao Liu
- Center of Medical Prenatal Diagnosis, Lishui Maternity and Child Health Care Hospital, Lishui, China
| | - Xingyu Zhang
- Shanghai Children's Medical Center, Institute of Pediatric Translational Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weilan Wang
- Department of Dermatology, Shaoxing Central Hospital, Shaoxing, China
| | - Xiaofang Lan
- Center of Medical Prenatal Diagnosis, Lishui Maternity and Child Health Care Hospital, Lishui, China
| | - Minyue Dong
- Department of Reproductive Genetics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Kai Yan
- Department of Reproductive Genetics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yongliang Lei
- Center of Medical Prenatal Diagnosis, Lishui Maternity and Child Health Care Hospital, Lishui, China
| | - Penglong Chen
- Center of Medical Prenatal Diagnosis, Lishui Maternity and Child Health Care Hospital, Lishui, China
| | - Mufeng Yang
- Center of Medical Prenatal Diagnosis, Lishui Maternity and Child Health Care Hospital, Lishui, China
| | - Qunda Shan
- Center of Medical Prenatal Diagnosis, Lishui Maternity and Child Health Care Hospital, Lishui, China
| | - Chunlei Jin
- Center of Medical Prenatal Diagnosis, Lishui Maternity and Child Health Care Hospital, Lishui, China
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5
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Heap J, Judge M, Padmakumar B. Harlequin ichthyosis from birth to 12 years. BMJ Case Rep 2020; 13:e235225. [PMID: 32847877 PMCID: PMC7451270 DOI: 10.1136/bcr-2020-235225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2020] [Indexed: 11/04/2022] Open
Abstract
A neonate was born with generalised, erythrodermic, thick, fissured skin, severe ectropion, hypoplastic auricles and limb abnormalities. A clinical diagnosis of harlequin ichthyosis was made, allowing supportive therapies to be commenced promptly. Oral acitretin was initiated on day 3 of life, complemented by an intensive skin care regimen. Rehydration, prevention and treatment of infection, temperature control and nutritional support were all essential to see him through the neonatal period. Nearly 12 years later, this child continues to receive multidisciplinary input and enjoys a good quality of life.
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Affiliation(s)
- Jemima Heap
- Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Mary Judge
- Salford Royal NHS Foundation Trust, Salford, UK
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Montalván-Suárez M, Esperón-Moldes US, Rodríguez-Pazos L, Ordóñez-Ugalde A, Moscoso F, Ugalde-Noritz N, Santomé L, Fachal L, Tettamanti-Miranda D, Ruiz JC, Ginarte M, Vega A. A novel ABCA12 pathologic variant identified in an Ecuadorian harlequin ichthyosis patient: A step forward in genotype-phenotype correlations. Mol Genet Genomic Med 2019; 7:e608. [PMID: 30916489 PMCID: PMC6503032 DOI: 10.1002/mgg3.608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/10/2019] [Accepted: 01/24/2019] [Indexed: 11/22/2022] Open
Abstract
Background Autosomal recessive congenital ichthyoses (ARCI) have been associated with different phenotypes including: harlequin ichthyosis (HI), congenital ichthyosiform erythroderma (CIE), and lamellar ichthyosis (LI). While pathogenic variants in all ARCI genes are associated with LI and CIE phenotypes, the unique gene associated with HI is ABCA12. In HI, the most severe ARCI form, pathogenic variants in both ABCA12 gene alleles usually have a severe impact on protein function. The presence of at least one non‐truncating variant frequently causes a less severe congenital ichthyosis phenotype (LI and CIE). Methods We report the case of a 4‐year‐old Ecuadorian boy with a severe skin disease. Genetic diagnosis was performed by NGS. In silico predictions were performed using Alamut software v2.11. A review of the literature was carried out to identify all patients carrying ABCA12 splice‐site and missense variants, and to explore their genotype‐phenotype correlations. Results Genetic testing revealed a nonsense substitution, p.(Arg2204*), and a new missense variant, p.(Val1927Leu), in the ABCA12 gene. After performing in silico analysis and a comprehensive review of the literature, we conclude that p.(Val1927Leu) affects a well conserved residue which could either disturb the protein function or alter the splicing process, both alternatives could explain the severe phenotype of our patient. Conclusion This case expands the spectrum of ABCA12 reported disease‐causing variants which is important to unravel genotype‐phenotype correlations and highlights the importance of missense variants in the development of HI.
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Affiliation(s)
- Martha Montalván-Suárez
- Sistema de Investigación y Desarrollo SINDE, Universidad Católica de Santiago de Guayaquil and Universidad de Guayaquil, Guayaquil, Ecuador
| | - Uxia Saraiva Esperón-Moldes
- Fundación Pública Galega de Medicina Xenómica-SERGAS, Grupo de Medicina Xenómica-USC, CIBERER, IDIS, Santiago de Compostela, Spain.,Departamento de Ciencias Forenses, Anatomía Patolóxica, Xinecoloxía, Obstetricia e Pediatría, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Laura Rodríguez-Pazos
- Servicio de Dermatología del Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Andrés Ordóñez-Ugalde
- Fundación Pública Galega de Medicina Xenómica-SERGAS, Grupo de Medicina Xenómica-USC, CIBERER, IDIS, Santiago de Compostela, Spain.,Laboratorio Biomolecular, Cuenca, Ecuador.,Unidad de Genética y Molecular del Hospital de Especialidades José Carrasco Arteaga, Cuenca, Ecuador
| | | | - Nora Ugalde-Noritz
- Unidad de Genética y Molecular del Hospital de Especialidades José Carrasco Arteaga, Cuenca, Ecuador
| | - Luis Santomé
- Fundación Pública Galega de Medicina Xenómica-SERGAS, Grupo de Medicina Xenómica-USC, CIBERER, IDIS, Santiago de Compostela, Spain
| | - Laura Fachal
- Fundación Pública Galega de Medicina Xenómica-SERGAS, Grupo de Medicina Xenómica-USC, CIBERER, IDIS, Santiago de Compostela, Spain
| | | | - Juan Carlos Ruiz
- Universidad Espíritu Santo and Hospital Luis Vernaza, Guayaquil, Ecuador.,Instituto de Biomedicina Universidad Católica de Santiago de Guayaquil and Centro de Investigación, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Manuel Ginarte
- Servicio de Dermatología del Complexo Hospitalario Universitario de Santiago, Facultad de Medicina, Santiago de Compostela, Spain
| | - Ana Vega
- Fundación Pública Galega de Medicina Xenómica-SERGAS, Grupo de Medicina Xenómica-USC, CIBERER, IDIS, Santiago de Compostela, Spain
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