A Rare Cause of Hypophosphatemia: Raine Syndrome Changing Clinical Features with Age

Raine Syndrome (RS) is caused by biallelic loss-of-function mutations in FAM20C gene and characterized by hypophosphatemia, typical facial and skeletal features. Subperiosteal bone formation and generalized osteosclerosis are the most common radiological findings. Here we present a new case with RS. A 9-month-old male patient on a home-type ventilator was referred for hypophosphatemia. He was born with a weight of 3800 g to non-consanguineous parents. Prenatal ultrasound had demonstrated nasal bone agenesis. A large anterior fontanel, frontal bossing, exophthalmos, hypoplastic nose, high arched palate, low set ears, triangular mouth, and corneal opacification were detected on physical examination. Serial skeletal X-rays revealed diffuse osteosclerosis at birth which was gradually decreased by the age of 5 months with subperiosteal undermineralized bone formation and medullary space of long bone could be distinguishable with bone-within-a-bone appearance. At 9 months of age, hand X-ray revealed cupping of the ulna with loose radial bone margin with minimal fraying and osteopenia. Cranial computed tomography scan showed bilateral periventricular calcification and hydrocephalus in progress. The clinical, laboratory, and radiological examinations were consistent with RS. Molecular analyses revealed a compound heterozygous mutation in FAM20C gene (a known pathogenic mutation, c.1645C > T, p.Arg549Trp; and a novel c.863 + 5 G > C variant). The patient died due to respiratory failure at 17 months of age. This case allowed us to demonstrate natural progression of skeletal features in RS. Furthermore, we have described a novel FAM20C variant causing RS. Previous literature on RS is also reviewed.

Incidence assessment of rotavirus and adenovirus associated acute gastroenteritis cases in early childhood

This study was undertaken to give an insight into the incidence of acute gastroenteritis cases of rotaviral/adenoviral aetiology in patients presenting to the emergency room of an inner-city government teaching hospital. Group A rotavirus and adenovirus serotype 40-41 antigen results were obtained via immunochromatography. In 2007, there were 1543 patients with gastroenteritis between 0-5 years of age whose stool samples were tested for rota and adenovirus, of whom 386 (25%) had positive stool samples for rotavirus, and 133 (8.6%) for adenovirus serotype 40-41. The majority of rotavirus (74.6%) and adenovirus (73%) cases were between 0-2 years of age. The peak season for rotavirus gastroenteritis was January (44%) and February (50.6%), whereas July (9.7%) and August (9%) were months of low incidence. For enteric adenoviral infections summer was the peak season, with August (20.9%) and July (17.3%) being the foremost months. Among the viral gastroenteritis cases, rotavirus infections were in the majority. A seasonal trend emerges for viral gastroenteritis: Rota virus infections are most frequently seen in winter whereas adenoviral infections prefer summer months. Both viruses mostly affect children up to 2 years.