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Baker EK, Al Gharaibeh FN, Bove K, Calvo-Garcia MA, Shillington A, VandenHeuvel K, Cortezzo DE. A novel RYR1 variant in an infant with a unique fetal presentation of central core disease. Am J Med Genet A 2023; 191:1646-1651. [PMID: 36965156 DOI: 10.1002/ajmg.a.63188] [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: 01/03/2023] [Revised: 02/20/2023] [Accepted: 03/13/2023] [Indexed: 03/27/2023]
Abstract
Ryanodine receptor type 1-related disorder (RYR1-RD) is the most common subgroup of congenital myopathies with a wide phenotypic spectrum ranging from mild hypotonia to lethal fetal akinesia. Genetic testing for myopathies is imperative as the diagnosis informs counseling regarding prognosis and recurrence risk, treatment options, monitoring, and clinical management. However, diagnostic challenges exist as current options are limited to clinical suspicion prompting testing including: single gene sequencing or familial variant testing, multi-gene panels, exome, genome sequencing, and invasive testing including muscle biopsy. The timing of diagnosis is of great importance due to the association of RYR1-RD with malignant hyperthermia (MH). MH is a hypermetabolic crisis that occurs secondary to excessive calcium release in muscles, leading to systemic effects that can progress to shock and death if unrecognized. Given the association of MH with pathogenic variants in RYR1, a diagnosis of RYR1-RD necessitates an awareness of medical team to avoid potentially triggering agents. We describe a case of a unique fetal presentation with bilateral diaphragmatic eventrations who had respiratory failure, dysmorphic facial features, and profound global hypotonia in the neonatal period. The diagnosis was made at several months of age, had direct implications on her clinical care related to anticipated need to long-term ventilator support, and ultimately death secondary an arrhythmia as a result of suspected MH. Our report reinforces the importance of having high suspicion for a genetic syndrome and pursuing early, rapid exome or genome sequencing as first line testing in critically ill neonatal intensive care unit patients and further evaluating the pathogenicity of a variant of uncertain significance in the setting of a myopathic phenotype.
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Affiliation(s)
- Elizabeth K Baker
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Faris N Al Gharaibeh
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Division of Neonatology, Cincinnati Children's Hospital Medicine, Cincinnati, Ohio, United States
| | - Kevin Bove
- Division of Pathology, Cincinnati Children's Hospital, Cincinnati, Ohio, United States
| | - Maria A Calvo-Garcia
- Radiology Department, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Amelle Shillington
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | | | - DonnaMaria E Cortezzo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Division of Neonatology, Cincinnati Children's Hospital Medicine, Cincinnati, Ohio, United States
- Department of Anesthesia, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Division of Pain and Palliative Medicine, Cincinnati Children's Hospital Medicine, Cincinnati, Ohio, United States
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Murofushi Y, Hayakawa I, Abe Y, Nakao H, Ono H, Kubota M. The most severe form of LMNA-associated congenital muscular dystrophy. Brain Dev 2022; 44:650-654. [PMID: 35729056 DOI: 10.1016/j.braindev.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
Alterations in the LMNA gene cause a wide spectrum of diseases collectively called laminopathies. LMNA-associated congenital muscular dystrophy is a form of laminopathy, which usually causes infantile onset of muscle weakness, predominantly in the cervical-axial muscles, and motor developmental retardation. Cardiac symptoms during the first decade of life are rare. We report a case of LMNA-associated congenital muscular dystrophy in which the patient did not achieve head control and experienced facial muscle weakness. Cardiac dysrhythmias were observed at 5 years with development of dilated cardiomyopathy and ischemic strokes at 7 years. Despite intensive medical intervention, he died suddenly at 9 years. This report broadens the spectrum of phenotypes of this disorder with the most severe symptoms during the first decade of life. Our case underscores the need for early genetic testing for LMNA in patients with congenital muscular dystrophy to screen for cardiac manifestations and intervene as necessary.
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Affiliation(s)
- Yuka Murofushi
- Division of Neurology, National Center for Child Health and Development (NCCHD), 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan.
| | - Itaru Hayakawa
- Division of Neurology, National Center for Child Health and Development (NCCHD), 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Yuichi Abe
- Division of Neurology, National Center for Child Health and Development (NCCHD), 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Hiro Nakao
- Department of General Pediatrics and Interdisciplinary Medicine, NCCHD, Tokyo, Japan
| | | | - Masaya Kubota
- Division of Neurology, National Center for Child Health and Development (NCCHD), 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan; Department of Pediatrics, Shimada Ryoiku Medical Center for Challenged Children, 1-31-1 Nakazawa, Tama City, Tokyo 206-0036, Japan
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Arattu Thodika F, Williams EE, Dassios T, Adu J, Nanjundappa M, Harris C, Greenough A. Physiological pulmonary assessments in the management of bilateral diaphragmatic eventration. CASE REPORTS IN PERINATAL MEDICINE 2022. [DOI: 10.1515/crpm-2021-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
To describe the importance of comprehensive assessment to determine the underlying diagnosis and the role of physiological pulmonary measurements in the management of congenital bilateral eventration of the diaphragm.
Case presentation
A female infant born at 34 weeks gestation required intubation and ventilation at birth. Chest radiographical imaging revealed bilateral density to the bases of both lung fields with raised hemi-diaphragms. Ultrasound imaging showed focal diaphragmatic eventration with bulging of the dome of the liver into the right and left hemithoraces. Assessment of the electrical activity of the diaphragm during a spontaneous breathing trial demonstrated a mean amplitude consistent with that of ventilated infants of the same gestational age with intact diaphragms. Hence she was extubated which was successful. Chest radiographic thoracic area measured post extubation was 1,654 mm2, equivalent to that of a term infant with severe congenital diaphragmatic hernia. As the electrical activity of the diaphragm was normal this suggests replacement of the diaphragmatic muscle tissue with fibrous bands was likely to be only partial, and hence why extubation was successful. She had other abnormalities presenting in the neonatal period including dermal melancytosis, central hypotonia, hyperinsulinism and poor feeding. The infant underwent extensive investigation which revealed a KMT2D gene mutation associated with Kabuki syndrome.
Conclusions
Physiological pulmonary measurements may add clinical management in bilateratal diaphragmatic eventration.
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Affiliation(s)
- Fahad Arattu Thodika
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Science and Medicine , King’s College London , London , UK
| | - Emma E. Williams
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Science and Medicine , King’s College London , London , UK
| | - Theodore Dassios
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Science and Medicine , King’s College London , London , UK
- Neonatal Intensive Care Centre , King’s College Hospital NHS Foundation Trust , London , UK
| | - John Adu
- Department of Paediatric Radiology , King’s College Hospital NHS Foundation Trust , London , UK
| | - Mahesh Nanjundappa
- Neonatal Intensive Care Centre , King’s College Hospital NHS Foundation Trust , London , UK
| | - Christopher Harris
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Science and Medicine , King’s College London , London , UK
- Neonatal Intensive Care Centre , King’s College Hospital NHS Foundation Trust , London , UK
| | - Anne Greenough
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Science and Medicine , King’s College London , London , UK
- Neonatal Intensive Care Centre , King’s College Hospital NHS Foundation Trust , London , UK
- King’s College London , London , UK
- NIHR Biomedical Research Centre based at Guy’s and St Thomas’ , NHS Foundation Trust and King’s College London , London , UK
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Naz S, Jaiswal V, Joshi A, Jarullah FA, Jain E, Neupane A. Heart on the left, diaphragm on the right: A case of congenital diaphragmatic eventration. Clin Case Rep 2021; 9:e05068. [PMID: 34849225 PMCID: PMC8607868 DOI: 10.1002/ccr3.5068] [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] [Received: 08/12/2021] [Revised: 09/25/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Congenital Diaphragmatic Eventration (DE) requires a prompt diagnosis to avert the potentially life-threatening complications. Herein, a 5-month-old male presented with recurrent respiratory infections due to a right-sided diaphragmatic eventration. Misdiagnosed from previous medical visits, timely surgical intervention by thoracoscopic plication of the diaphragm was crucial for our patient's survival.
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Affiliation(s)
- Sidra Naz
- University of Health ScienceLahorePakistan
| | | | | | | | - Esha Jain
- Larkin Community HospitalSouth MiamiFloridaUSA
| | - Asmita Neupane
- Kathmandu Medical College Teaching HospitalKathmanduNepal
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