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Karmouta R, Tsui I, Khitri M. Familial Exudative Vitreoretinopathy Initially Diagnosed as Incontinentia Pigmenti in an Asymptomatic Teenager: A Case Report. Case Rep Ophthalmol 2023; 14:640-646. [PMID: 38023608 PMCID: PMC10673348 DOI: 10.1159/000533632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/14/2023] [Indexed: 12/01/2023] Open
Abstract
In this case report, we aim to illustrate a presentation of familial exudative vitreoretinopathy (FEVR) that closely resembles incontinentia pigmenti (IP) and the role of genetic testing that is of no cost to the patient in providing the correct diagnosis. We present a case of an 11-year-old female-to-male transgender patient with a history of hypodontia and skin hypopigmentation who was incidentally found to have a retinal lesion on ultra-widefield fundus imaging during routine screening. Ultra-widefield fluorescein angiography confirmed bilateral peripheral ischemic retinopathy that was successfully treated with laser. The patient was presumed to have IP; however, genetic testing was negative. Due to cost, further genetic testing was declined by the family, and the patient had no further ocular complaints. At age 16, genetic testing became available to the patient, and the patient was found to have FEVR with LRP5 mutation. The patient began screening for comorbidities associated with LRP5 mutation. This case highlights how the ophthalmologic findings of FEVR can present identically to those of IP, and genetic testing is an invaluable tool in distinguishing between these two pathologies. Correct diagnosis of FEVR is vital in assessing other comorbidities of the disease, including osteoporosis. Furthermore, increased use of ultra-widefield fundus imaging in routine eye screening may be of great benefit for community screening of retinal disease, and ultra-widefield fluorescein angiography is of significant use in the diagnosis of FEVR.
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Affiliation(s)
- Reem Karmouta
- David Geffen School of Medicine, Stein Eye Institute, Doheny Eye Institute, Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA, USA
| | - Irena Tsui
- David Geffen School of Medicine, Stein Eye Institute, Doheny Eye Institute, Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA, USA
| | - Monica Khitri
- David Geffen School of Medicine, Stein Eye Institute, Doheny Eye Institute, Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA, USA
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Danford ID, Scruggs BA, Capone A, Trese MT, Drenser KA, Thanos A, Nudleman E, Amphornphruet A, Tipsuriyaporn B, Hubbard GB, Ells A, Harper CA, Goldstein J, Calvo C, Wallace-Carrete C, Berry D, Chang E, Leishman L, Shapiro M, Blair M, Mikhail M, Shields CL, Schwendeman R, Yonekawa Y, Gupta MP, Orlin A, Prakhunhungsit S, Mukai S, Berrocal A, Hartnett ME, Campbell JP. The Prevalence of Retinal Disease and Associated CNS Disease in Young Patients with Incontinentia Pigmenti. Ophthalmol Retina 2022; 6:1113-1121. [PMID: 35691580 DOI: 10.1016/j.oret.2022.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE To evaluate the prevalence of retinal disease on fluorescein angiography (FA) in patients with incontinentia pigmenti (IP) and to compare the severity of retinal disease in those with and without known central nervous system (CNS) disease. DESIGN Multi-institutional consecutive retrospective case series. SUBJECTS New patients with a diagnosis of IP were seen at the Casey Eye Institute at the Oregon Health and Science University (OHSU), Moran Eye Center, University of Utah, or Bascom Palmer Eye Institute, University of Miami from December 2011 to September 2018. METHODS Detailed ophthalmoscopic examination and FA were recommended for all new patients and performed on every patient who had parental consent. Ophthalmoscopic findings and FA images were graded for severity by 2 masked graders on a 3-point scale: 0 = no disease, 1 = vascular abnormalities without leakage, 2 = leakage or neovascularization, and 3 = retinal detachment. The presence of known CNS disease was documented. Additional cases were obtained from a pediatric retina listserv for examples of phenotypic variation. MAIN OUTCOME MEASURES The proportion of eyes noted to have disease on ophthalmoscopy compared with FA and the severity of retinal disease in those with and without known CNS disease. RESULTS Retinal pathology was detected in 18 of 35 patients (51%) by indirect ophthalmoscopy and 26 of 35 patients (74%) by FA (P = 0.048) in a predominantly pediatric population (median age, 9 months). Ten patients (29%) had known CNS disease at the time of the eye examination. A Wilcoxon rank-sum test indicated that the retinal severity scores for patients with CNS disease (median, 2) were significantly higher than the retinal severity scores for patients without CNS disease (median, 1), z = -2.12, P = 0.034. CONCLUSIONS Retinal disease is present in the majority of patients with IP, and ophthalmoscopic examination is less sensitive than FA for detection of disease. There may be a correlation between the severity of retinal and CNS disease.
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Affiliation(s)
- Ian D Danford
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon
| | - Brittni A Scruggs
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon; Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Kim A Drenser
- Associated Retinal Consultants, PC, Royal Oak, Michigan
| | - Aristomenis Thanos
- Associated Retinal Consultants, PC, Royal Oak, Michigan; Legacy Devers Eye Institute, Portland, Oregon
| | - Eric Nudleman
- Associated Retinal Consultants, PC, Royal Oak, Michigan; Shiley Eye Institute, University of California, San Diego, La Jolla, California
| | - Atchara Amphornphruet
- Queen Sirikit National Institute of Child Health, Department of Ophthalmology, Bangkok, Thailand
| | - Boontip Tipsuriyaporn
- Queen Sirikit National Institute of Child Health, Department of Ophthalmology, Bangkok, Thailand
| | | | - Anna Ells
- Calgary Retina Consultants, Calgary, Alberta, Canada
| | | | | | | | | | - Duncan Berry
- Charlotte Eye, Ear, Nose & Throat Associates, P.A., Charlotte, North Carolina
| | | | | | | | | | - Mikel Mikhail
- Lakeridge Health, Queen's University, Ontario, Canada
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University Philadelphia, Pennsylvania
| | - Rachel Schwendeman
- Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University Philadelphia, Pennsylvania
| | - Yoshihiro Yonekawa
- Mid Atlantic Retina, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mrinali P Gupta
- Retina Associates of Orange County, Laguna Hills, California; Weill Cornell Medical College, New York, New York
| | - Anton Orlin
- Weill Cornell Medical College, New York, New York
| | | | - Shizuo Mukai
- Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Audina Berrocal
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida
| | | | - J Peter Campbell
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon.
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Madan S, Chaudhuri Z. Persistent hyperplastic primary vitreous in a child with incontinentia pigmenti and infantile spasms. Oman J Ophthalmol 2022; 15:363-365. [PMID: 36760927 PMCID: PMC9905884 DOI: 10.4103/ojo.ojo_194_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/12/2021] [Accepted: 08/30/2021] [Indexed: 02/11/2023] Open
Abstract
Incontinentia pigmenti (IP) is a rare neurocutaneous syndrome of X-linked dominant inheritance (1:40000 births in the Caucasian population) which is usually lethal in males. It commonly presents with skin, central nervous system, and dental anomalies. Ophthalmic associations of IP include intra-ocular anomalies such as leukocoria, megalocornea, corneal edema, band keratopathy, bullous keratopathy, iridocorneal attachments, macular capillary dropout, peripheral arteriovenous shunts, retinal neovascularization, vitreous hemorrhage, preretinal fibrosis, traction retinal detachment as well as strabismus. We report an 18-month-old developmentally delayed female child with diagnosed IP and infantile spasms conforming to the west syndrome triad, who presented with left eye microphthalmia and persistent hyperplastic primary vitreous and discuss this rare ophthalmic presentation.
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Affiliation(s)
- Siddharth Madan
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, New Delhi, India
| | - Zia Chaudhuri
- Department of Ophthalmology, Lady Hardinge Medical College and Associated Hospitals, University of Delhi, Dr. RML Hospital and ABVIMS, New Delhi, India,Address for correspondence: Prof. Zia Chaudhuri, Department of Ophthalmology, Lady Hardinge Medical College and Associated Hospitals, University of Delhi, Dr. RML Hospital and ABVIMS, New Delhi, India. E-mail:
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Li WC, Li ML, Ding JW, Wang L, Wang SR, Wang YY, Xiao LF, Sun T. Incontinentia pigmenti with intracranial arachnoid cyst: A case report. World J Clin Cases 2022; 10:8352-8359. [PMID: 36159532 PMCID: PMC9403704 DOI: 10.12998/wjcc.v10.i23.8352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/25/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Incontinentia pigmenti (IP) is a rare X-linked dominant genetic disorder that can be fatal in male infants. It is a disease that affects many systems of the human body. In addition to characteristic skin changes, patients may also have pathological features of the eyes, teeth, and central nervous system. Therefore, the lesions in these systems may be the first symptoms for which patients seek treatment. To date, no cases of IP complicated by intracranial arachnoid cyst (IAC) have been reported. This paper aims to report a case of IP with IAC in order to share the diagnosis and treatment experience of this rare case with other clinicians.
CASE SUMMARY An 11-year-old female patient suffered intermittent limb convulsions for five months and was sent to hospital. In the initial stage, the patient was considered to have primary epilepsy. Further investigation of the patient's medical history, physical examination and imaging examination led to the diagnosis of IP combined with intracranial space-occupying lesions, and secondary epilepsy. The patient was treated with craniotomy, and postoperative pathology revealed an IAC. The patient recovered well after craniotomy and had no obvious surgery-related complications. During the follow-up period, the patient did not have recurrent epilepsy symptoms.
CONCLUSION IP is a multi-system disease that presents with typical skin lesions at birth, but the long-term prognosis of this disease depends on the involvement of systems other than the skin, especially nervous system and ocular lesions.
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Affiliation(s)
- Wen-Chao Li
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan 750000, Ningxia Hui Autonomous Region, China
- Department of Neurosurgery, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang 453000, Henan Province, China
| | - Man-Li Li
- Department of Physiology, Sanquan College of Xinxiang Medical University, Xinxiang 453000, Henan Province, China
| | - Jiang-Wei Ding
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Lei Wang
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Shu-Ren Wang
- Department of Neurosurgery, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang 453000, Henan Province, China
| | - Yang-Yang Wang
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Li-Fei Xiao
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Tao Sun
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan 750000, Ningxia Hui Autonomous Region, China
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Kawai M, Sugimoto A, Ishihara Y, Kato T, Kurahashi H. Incontinentia pigmenti inherited from a father with a low level atypical IKBKG deletion mosaicism: a case report. BMC Pediatr 2022; 22:378. [PMID: 35768795 PMCID: PMC9241235 DOI: 10.1186/s12887-022-03444-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 06/22/2022] [Indexed: 05/31/2023] Open
Abstract
Background Incontinentia pigmenti (IP) is an X-liked dominant genodermatosis caused by mutations of the IKBKG/NEMO gene. IP is mostly lethal in males in utero, and only very rare male cases with a somatic mosaic mutation or a 47,XXY karyotype have been reported. Case presentation We here report a case of an IKBKG gene deletion in a female infant presenting with a few blisters and erythema in her upper arms at birth. MLPA analysis revealed a rare 94 kb deletion in this patient, encompassing the IKBKG gene and IKBKGP pseudogene. PCR analysis indicated the presence of Alu elements at both ends of the deletion, suggesting non-allelic homologous recombination as an underlying mechanism. Notably, a low-level mosaic deletion was identified in her father’s peripheral blood leukocytes by PCR, suggesting a rare father-to-daughter transmission of IP. Conclusion In family studies for an apparently sporadic IP case, parental analysis that includes the father is recommended due to the possibility of male mosaicism.
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Affiliation(s)
- Miki Kawai
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.,Department of Clinical Genetics, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, 460-0001, Japan
| | - Atsuya Sugimoto
- Department of Neonatology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, 605-0981, Japan
| | - Yasunori Ishihara
- Department of Pediatrics, Fukui Aiiku Hospital, Shinbo, Fukui, 910-0833, Japan
| | - Takema Kato
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hiroki Kurahashi
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
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Cai YR, Liang Y, Zhong X. Late contralateral recurrence of retinal detachment in incontinentia pigmenti: A case report. World J Clin Cases 2022; 10:4171-4176. [PMID: 35665106 PMCID: PMC9131234 DOI: 10.12998/wjcc.v10.i13.4171] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/07/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Incontinentia pigmenti (IP) is a rare X-linked genetic disease. It mainly manifests as skin lesions and causes problems in the eyes, teeth, bones, and central nervous system. Of the various ocular manifestations, the most severe with difficult recovery is retinal detachment (RD). Here, we report an unusual case of bilateral asymmetrical RD.
CASE SUMMARY We present the case of an 11-year-old Chinese girl with IP who complained of sudden blurring of vision in the left eye. At that time, she had been blind in her right eye for 4 years. RD with traction was observed in both eyes. A massive retinal proliferative membrane, exudation, and hemorrhage were seen in the left eye. We performed vitrectomy in her left eye. Her visual acuity recovered to 20/50, and her retina had flattened within 2 d after surgery. During the 3-mo follow-up, we performed retinal laser treatment of the non-perfused retinal area in her left eye. Eventually, her visual acuity returned to 20/32, and no new retinal abnormalities developed.
CONCLUSION In patients with IP with fundal abnormalities in one eye, it is important to focus on the rate of fundal change in the other eye. RD in its early stages can be effectively treated with timely vitrectomy and laser photocoagulation.
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Affiliation(s)
- You-Ran Cai
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Yong Liang
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
| | - Xin Zhong
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Province, China
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Rr P, Douch C, Aan Koh MJ, Lai AHM, Lim CT, Hartley L, Thomas T, Yeo TH. Speckled brain lesions in Incontinentia Pigmenti patients with acquired brain syndromes. Eur J Paediatr Neurol 2021; 33:106-111. [PMID: 34133990 DOI: 10.1016/j.ejpn.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/26/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022]
Abstract
Incontinentia Pigmenti (IP) is a neurocutaneous syndrome, with malformations of cortical development and neurodevelopmental delay in some patients. Neonates with IP may develop acute encephalopathy with multifocal ischemic brain lesions with a speckled pattern on diffusion-weighted magnetic resonance imaging (MRI). We observed a similar MRI pattern in 4 female patients with IP who presented with childhood acute encephalopathy syndromes. These patients, aged 9 days to 13 years old, had acute neonatal encephalitis, Influenza A virus related acute necrotizing encephalopathy (ANE) of childhood, Influenza B virus related acute encephalopathy with biphasic seizures and late restricted diffusion (AESD) and acute disseminated encephalitis (ADEM) with transverse myelitis (TM). These lesions could possibly reflect the white matter changes in IP patients with encephalopathy.
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Affiliation(s)
- Pravin Rr
- General Pediatrics, KK Women's & Children's Hospital, Singapore.
| | - Catherine Douch
- General Pediatrics, University College London Hospital, United Kingdom
| | | | - Angeline H M Lai
- Genetics Service, Department of Pediatrics, KK Women's & Children's Hospital, Singapore
| | - Cc Tchoyoson Lim
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | - Louise Hartley
- Pediatric Neurology, The Royal London Hospital, United Kingdom
| | - Terrence Thomas
- Pediatric Neurology Service, KK Women's & Children's Hospital, Singapore
| | - Tong Hong Yeo
- Pediatric Neurology Service, KK Women's & Children's Hospital, Singapore
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Kanai S, Okanishi T, Kawai M, Yoshino G, Tsubouchi Y, Nishimura Y, Sakuma H, Kurahashi H, Maegaki Y. Late-onset cerebral arteriopathy in a patient with incontinentia pigmenti. Brain Dev 2021; 43:580-584. [PMID: 33419638 DOI: 10.1016/j.braindev.2020.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/07/2020] [Accepted: 12/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Incontinentia pigmenti (IP) is an X-linked neurocutaneous disorder that can present with cerebral arteriopathy during early infancy. However, no previous reports have demonstrated arteriopathic manifestations during postinfantile childhood in patients with IP. PATIENT DESCRIPTION We describe a case of IP in a 2-year-old girl who developed encephalopathic manifestations associated with influenza A infection. She presented diffuse magnetic resonance imaging abnormalities involving the cortices, subcortical white matter, corpus callosum, basal ganglia, and thalami, resembling the findings in early infantile cases reported in the previous literatures. Magnetic resonance angiography demonstrated attenuation of the cerebral arteries. Proinflammatory cytokines and chemokines were upregulated in the cerebrospinal fluid. Left hemiplegia remained following the remission of the arteriopathic manifestations. Genetic analyses revealed a novel type of mutation in the IKBKG gene. CONCLUSION Our findings indicate that patients with IP can develop destructive cerebral arteriopathy even after early infancy. The similarities in magnetic resonance imaging abnormalities between our patient and the previously reported infantile patients may be explained by the underlying immunologic pathophysiology of IP.
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Affiliation(s)
- Sotaro Kanai
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Japan.
| | - Tohru Okanishi
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Japan
| | - Miki Kawai
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Japan
| | - Go Yoshino
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Japan; Emergency Department, Hyogo Prefectural Kobe Children's Hospital, Japan
| | | | - Yoko Nishimura
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Japan
| | - Hiroshi Sakuma
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science, Japan
| | - Hiroki Kurahashi
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Japan
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Kim HY, Song HB, Kim KH, Kim JH, Chae JH, Kim MJ, Seong MW, Ko JM. Importance of extracutaneous organ involvement in determining the clinical severity and prognosis of incontinentia pigmenti caused by mutations in the IKBKG gene. Exp Dermatol 2021; 30:676-683. [PMID: 33655605 DOI: 10.1111/exd.14313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/13/2021] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
Incontinentia pigmenti (IP) is a rare X-linked skin disease caused by mutations in the IKBKG gene, which is required for activation of the nuclear factor-kappa B signalling pathway. Multiple systems can be affected with highly variable phenotypic expressivity. We aimed to clarify the clinical characteristics observed in molecularly confirmed Korean IP patients. The medical records of 25 females confirmed as IP by molecular genetic analysis were retrospectively reviewed. The phenotypic score of extracutaneous manifestations was calculated to assess the disease severity. The IKBKG gene partial deletion or intragenic mutations were investigated using long-range PCR, multiplex ligation-dependent probe amplification and direct sequencing methods. Among the 25 individuals, 18 (72%) were sporadic cases. All patients showed typical skin manifestations at birth or during the neonatal period. Extracutaneous findings were noted in 17 (68%) patients; ocular manifestations (28%), neurological abnormalities (28%), hair abnormalities (20%), dental anomalies (12%), nail dystrophy (8%). The common exon 4-10 IKBKG deletion was observed in 20 (80%) patients. In addition, five intragenic sequence variants were identified, including three novel variants. The phenotype scores were highly variable, ranging from abnormal skin pigmentation only to one or more extracutaneous features, although no significant difference was observed for each clinical characteristic between the group with sequence variants and that with common large deletion. Our cohort with IP showed heterogeneity of extracutaneous manifestations and high incidence of sporadic cases. Long-term monitoring with multidisciplinary management is essential for evaluating the clinical status, providing adequate genetic counselling and understanding the genotype-phenotype correlation in IP.
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Affiliation(s)
- Hwa Young Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Beom Song
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Han Kim
- Department of Dermatology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Hun Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Rare Disease Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Man Jin Kim
- Rare Disease Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Min Ko
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Rare Disease Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Nakao S, Nishina S, Tanaka S, Yoshida T, Yokoi T, Azuma N. Early laser photocoagulation for extensive retinal avascularity in infants with incontinentia pigmenti. Jpn J Ophthalmol 2020; 64:613-620. [PMID: 32901400 DOI: 10.1007/s10384-020-00768-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 07/16/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE To describe the clinical features and treatment outcomes of severe retinopathy in eyes with incontinentia pigmenti (IP) of infants within a few months of birth. STUDY DESIGN Retrospective clinical study. METHODS Six eyes of three patients (6-day-old girl, 5-month-old girl, and 14-day-old boy) with IP were examined and treated under general anesthesia. Ophthalmologic examinations were performed including images from wide-angle fluorescein angiography (FA), swept-source optical coherence tomography (OCT), and OCT angiography (OCTA). RESULTS Ophthalmoscopy showed prominent vascular tortuosity in five eyes, retinal hemorrhages in four eyes, and incomplete vascular development in two eyes. FA showed extensive avascularity including the posterior pole of the retina in all cases except one eye. Prompt and intensive laser photocoagulation stabilized the pre-proliferative severe retinopathy in five eyes; however, foveal structure and vessel anomalies were detected in three of six eyes by OCT and two of five eyes by OCTA. CONCLUSION Severe retinopathy in the neonatal period and infancy was present not only in the periphery but also in the posterior pole including the fovea, which might be related to retinal vascular maldevelopment. It is, therefore, recommended that wide-angle fundus FA examination be performed in the early postnatal period to detect early signs of severe retinopathy in infants with IP.
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Affiliation(s)
- Shiro Nakao
- Laboratory for Visual Science, Department of Ophthalmology, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, Japan
| | - Sachiko Nishina
- Laboratory for Visual Science, Department of Ophthalmology, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, Japan
| | - Shin Tanaka
- Laboratory for Visual Science, Department of Ophthalmology, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, Japan
| | - Tomoyo Yoshida
- Laboratory for Visual Science, Department of Ophthalmology, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, Japan
| | - Tadashi Yokoi
- Laboratory for Visual Science, Department of Ophthalmology, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, Japan
| | - Noriyuki Azuma
- Laboratory for Visual Science, Department of Ophthalmology, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, Japan.
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11
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Michel S, Reynaud C, Daruich A, Hadj-Rabia S, Bremond-Gignac D, Bodemer C, Robert MP. Early management of sight threatening retinopathy in incontinentia pigmenti. Orphanet J Rare Dis 2020; 15:223. [PMID: 32854719 PMCID: PMC7450972 DOI: 10.1186/s13023-020-01509-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early blindness secondary to incurable retinal detachment is one of the main complications of incontinentia pigmenti (IP). The efficiency of ophthalmological management for preventing such evolution has not been proven. The objective of this retrospective study was to report a screening and treatment strategy of the vascular retinopathy in newborns and infants with IP. RESULTS All files of patients diagnosed with IP within the two first months of life in a single tertiary referral center, between 2010 and 2015, were retrospectively included. The minimum follow-up duration was three years. Patients had undergone systematic indirect ophthalmoscopy examination, looking for signs of peripheric retinal vasculopathy, according to a standardized schedule: at diagnosis, at age 1, 2, 3, 6, 9, 12, 18 and 24 months, and then once a year. Urgent laser therapy was performed under anesthesia in case of signs of retinal ischemia. Nineteen children files (17 girls) were studied. Median age at IP diagnosis was 1 day [0-44]; median age at first retinal evaluation was 25 days. Retinal manifestations occurred in 7 patients (n = 10/38 eyes, 26.3%); they were diagnosed at median age 19 days [3-59]. These patients underwent one or two ablative session per eye (mean 1.7, median 2), under general anaesthesia. No retinal detachment or fold occurred during the follow-up (median 6 years [3-9.8]). CONCLUSION Ocular screening should be performed in all cases of IP as soon as possible after diagnosis. A strict ophthalmological monitoring and prophylactic treatment of retinal vasculopathy can efficiently prevent the early blinding complications of the disease.
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Affiliation(s)
- Sarah Michel
- Ophthalmology Department and Rare Eye Disease Reference Center OPHTARA, Necker-Enfants malades University Hospital, AP-HP, Paris, France.
| | - Clothilde Reynaud
- Ophthalmology Department and Rare Eye Disease Reference Center OPHTARA, Necker-Enfants malades University Hospital, AP-HP, Paris, France
| | - Alejandra Daruich
- Ophthalmology Department and Rare Eye Disease Reference Center OPHTARA, Necker-Enfants malades University Hospital, AP-HP, Paris, France.,INSERM, UMRS1138, Team 17, From Physiopathology of Ocular Diseases to Clinical Development, Paris University, Paris, France
| | - Smail Hadj-Rabia
- Dermatology Department and Genodermatoses and Rare Skin Diseases Reference Center MAGEC, Necker-Enfants malades University Hospital, AP-HP, Paris, France.,INSERM U1163, Institut IMAGINE, Paris, France
| | - Dominique Bremond-Gignac
- Ophthalmology Department and Rare Eye Disease Reference Center OPHTARA, Necker-Enfants malades University Hospital, AP-HP, Paris, France.,INSERM, UMRS1138, Team 17, From Physiopathology of Ocular Diseases to Clinical Development, Paris University, Paris, France
| | - Christine Bodemer
- Dermatology Department and Genodermatoses and Rare Skin Diseases Reference Center MAGEC, Necker-Enfants malades University Hospital, AP-HP, Paris, France.,INSERM U1163, Institut IMAGINE, Paris, France
| | - Matthieu P Robert
- Ophthalmology Department and Rare Eye Disease Reference Center OPHTARA, Necker-Enfants malades University Hospital, AP-HP, Paris, France.,Borelli Centre, UMR 9010, CNRS-SSA-ENS Paris Saclay-Paris University, Paris, France
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12
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Martínez-Gayosso A, García-Romero MT. Incontinentia pigmenti: multisistemic genodermatosis. Bol Med Hosp Infant Mex 2020; 77:112-118. [PMID: 32496467 DOI: 10.24875/bmhim.19000173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Incontinentia pigmenti is an X-linked genodermatosis generally lethal in males; thus, it presents almost exclusively in females. It is caused by a loss-of-function mutation in the IKBKG (inhibitor of kappa polypeptide gene enhancer in B cells, kinase gamma) gene that prevents the NFкβ (nuclear factor kappa-light-chain-enhancer of activated B cells) protein from migrating to the nucleus to begin the transcription of factors that amplify the immune response and prevent apoptosis. Consequently, mutant cells become vulnerable to apoptosis when exposed to cytokines and, in turn, lead to vaso-occlusion and ischemia of tissues, such as the skin, the central nervous system and the retina. Dermatological lesions are characteristic and occur in 100% of patients; they are distributed along Blaschko lines, which follow the pattern of migration of skin cells in embryogenesis. The cutaneous manifestations follow a sequence of four phases since birth: vesicular, verrucous, hyperpigmented and hypopigmented. These lesions are relevant for the disease because they guide the clinician towards the diagnosis. Additionally, they are accompanied by neurological abnormalities, such as seizures, and multiple ophthalmological manifestations, such as retinal detachment. Incontinentia pigmenti patients with no clinically significant ophthalmic or neurological compromise have a good prognosis and a normal life expectancy. The abnormalities present are permanent, which can be a cause of concern for the patients.
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13
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Chambelland A, Aubert H, Bourrat E, Morice-Picard F, Puzenat E, Lacour JP, Chiaverini C. Incontinentia pigmenti in boys: Causes and consequences. Ann Dermatol Venereol 2020; 147:188-193. [PMID: 31982174 DOI: 10.1016/j.annder.2019.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/06/2019] [Accepted: 07/10/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Incontinentia pigmenti (IP) is an X-linked genodermatosis caused by mutation of the NEMO/IKBKG gene. While lethal in male foetuses, heterozygous females survive because of X-inactivation mosaicism. Herein we discuss 9 male patients with IP. MATERIALS AND METHODS This is an observational, descriptive, retrospective, multicentre, French study carried out with the help of the SFDP research group. Statistical analysis was performed both on our own patients and on those reported in the literature. RESULTS Nine boys with no family history of IP but with typical neonatal skin reactions were included. Genetic analysis of blood (n=8) and skin biopsy (n=3) confirmed the diagnosis of IP by identification of common deletion of the IKBKG/NEMO gene (exons 4 to 10) in the state of somatic mosaic in 6 and 2 cases respectively. Where analysed, the karyotype was normal (n=6). Over a median follow-up period of 48 months (3 months to 10 years), 3 patients had neurological abnormalities, 2 had severe ophthalmologic abnormalities, and 1 had dental abnormalities. Extensive skin involvement is a systemic risk factor, unlike cutaneous scarring. CONCLUSION IP in boys is often due to a mosaic mutation that should be sought in blood and skin. Long-term neurological and ophthalmological monitoring is essential, especially in cases of extensive skin involvement.
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Affiliation(s)
- A Chambelland
- Dermatology department, hôpital l'Archet 2, Nice university hospital, 06200 Nice, France.
| | - H Aubert
- Dermatology department, Nantes university hospital, 44093 Nantes, France
| | - E Bourrat
- Dermatology department, Saint-Louis hospital, AP-HP, 75000 Paris, France
| | - F Morice-Picard
- Dermatology department, hôpital Pellegrin, Bordeaux university hospital, 33000 Bordeaux, France
| | - E Puzenat
- Dermatology department, Jean-Minjoz university hospital, Besançon, 25000 Besançon, France
| | - J P Lacour
- Dermatology department, hôpital l'Archet 2, Nice university hospital, 06200 Nice, France
| | - C Chiaverini
- Dermatology department, hôpital l'Archet 2, Nice university hospital, 06200 Nice, France
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14
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Taieb C, Hadj-Rabia S, Monnet J, Bennani M, Bodemer C. Incontinentia pigmenti burden scale: designing a family burden questionnaire. Orphanet J Rare Dis 2019; 14:271. [PMID: 31771608 PMCID: PMC6880510 DOI: 10.1186/s13023-019-1234-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Incontentia pigmenti (IP) is a rare multisystem disorder of ectodermal origin comprising skin, dental, ocular and central nervous system features. Symptomatic treatments are adapted to each family according to the patient's disability. Due to its rarity, the family IP burden in its broadest sense (psychological, social, economic and physical) has not yet been evaluated. AIM To design a questionnaire allowing assessing the family burden of IP (F'BoIP). METHOD A questionnaire was developed using a standardized methodology for designing quality of life questionnaires according to the following steps: conception, development, and validation. A multidisciplinary working group was designed, including experts in questionnaire development, dermatologists specialised in IP patient care and representatives of the French IP association. A cultural and linguistic validation into US English was conducted, based on the original French version. RESULTS A 20-item conceptual questionnaire was generated. Subsequent confirmatory analyses produced a 20-item questionnaire grouped into four domains, demonstrating internal consistency (Cronbach's alpha: 0.93), reproducibility and high reliability. The F'BoIP questionnaire significantly correlated with other validated questionnaires: Family Dermatology Life Quality Index (F-DLQI), Perceived Stress Scale (PSS) and SF-12 mental and SF12 physical scores, indicating good external validity. CONCLUSION The F'BoIP questionnaire is the first specific tool to assess the family burden of IP and can be used by both family members of IP patients and by health care professionals. It is a valuable tool which evaluates medical and nonmedical strategies to improve the daily life of families affected by this orphan disease.
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Affiliation(s)
- Charles Taieb
- French Rare Diseases Healthcare Network Department of Dermatology, Necker Enfants Malades Hospital Paris, APHP, Paris, France. .,FIMARAD, Hôpital Necker-Enfants Malades, APHP, Paris, France.
| | - Smail Hadj-Rabia
- French Rare Diseases Healthcare Network Department of Dermatology, Necker Enfants Malades Hospital Paris, APHP, Paris, France.,Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker-Enfants Malades Hospital (AP-HP) and Imagine Institute, Paris Descartes-Sorbonne Paris Cité University, Paris, France
| | - Jacques Monnet
- French Association of Incontentia Pigmentosa Patients, Paris, France
| | | | - Christine Bodemer
- French Rare Diseases Healthcare Network Department of Dermatology, Necker Enfants Malades Hospital Paris, APHP, Paris, France.,Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker-Enfants Malades Hospital (AP-HP) and Imagine Institute, Paris Descartes-Sorbonne Paris Cité University, Paris, France
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15
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Moro R, Fabiano A, Calzavara-Pinton P, Cardinale J, Palumbo G, Giliani S, Lanzi G, Antonelli F, De Simone M, Martelli P, Fazzi E, Pinelli L, Gualdi G. Incontinentia Pigmenti Associated with Aplasia Cutis Congenita in a Newborn Male with Klinefelter Syndrome: Is the Severity of Neurological Involvement Linked to Skin Manifestations? Dermatol Ther (Heidelb) 2020; 10:213-20. [PMID: 31691923 DOI: 10.1007/s13555-019-00336-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Indexed: 11/18/2022] Open
Abstract
We report a rare case of a newborn male affected by incontinentia pigmenti, Klinefelter syndrome, and aplasia cutis congenita, who developed severe cutaneous, neurological, and ophthalmological manifestations. Genetic analysis showed the presence of the common mutation of NEMO (exon 4–10 deletion), Klinefelter syndrome karyotype (47 XXY), and random X inactivation. This is in accordance with the severity of involvement of the affected tissues (skin, central nervous system, and retina). Indeed, the patient developed typical skin lesions all over the body, except the head. Equally, multiple lesions diffusely involving both the cortical grey matter and subcortical white matter of the cerebellum and cerebral hemispheres were observed. Discussing current knowledge about the etiopathogenesis of skin and brain lesions in incontinentia pigmenti, our case seems to support the proapoptotic origin of central nervous system involvement. Possibly, incontinentia pigmenti patients suffer an impaired protection against apoptosis at the level of cerebral endothelial cells of small vessels, leading to vascular damage and subsequent ischemic brain lesions.
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16
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Kunzmann S, Ngyuen T, Stahl A, Walz JM, Nentwich MM, Speer CP, Ruf K. Necrotizing enterocolitis after intravitreal bevacizumab in an infant with Incontinentia Pigmenti - a case report. BMC Pediatr 2019; 19:353. [PMID: 31615465 DOI: 10.1186/s12887-019-1732-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 09/20/2019] [Indexed: 11/17/2022] Open
Abstract
Background Incontinentia Pigmenti is a rare disease affecting multiple organs. Fifty of patients show affection of the eye with retinopathy and possible amaurosis being the worst outcome. Treatment has commonly been panretinal laser coagulation but intravitreal application of bevacizumab as VEGF-inhibitor has shown to effectively suppress retinal neovascularization. Case presentation A six-week-old female infant with Incontinentia Pigmenti developed a foudroyant necrotizing enterocolitis shortly after intravitreal injection of bevazicumab due to a retinopathy with impending tractional detachment of the left eye. Since the onset of abdominal symptoms occurred immediately after the intravitreal application, a link between the two events seemed likely. Sequential analyses of the VEGF serum concentrations showed a massive suppression of endogenous VEGF with only a very slow recovery over weeks. Such a severe systemic adverse event has not been reported after intravitreal treatment with bevacizumab in an infant. Conclusion This case report shows a relevant systemic uptake of bevacizumab after intravitreal application as suppressed VEGF levels show. There seems to be a connection between suppressed VEGF levels and the onset of necrotizing enterocolitis. Therefore, treatment with bevacizumab should be carefully considered and further research is needed to assess this drug’s safety profile.
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17
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Ogasawara K, Honda Y, Maeda H, Sato M, Nakano H, Hosoya M. Corticosteroid Therapy in Neonatal Incontinentia Pigmenti With Asymptomatic Cerebral Lesions. Pediatr Neurol 2019; 99:85-87. [PMID: 31201074 DOI: 10.1016/j.pediatrneurol.2019.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/04/2019] [Accepted: 04/10/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Kei Ogasawara
- Department of Premature and Neonatal Medicine, Iwaki City Medical Center, Fukushima, Japan; Department of Pediatrics, Fukushima Medical University, Fukushima, Japan.
| | - Yoshinobu Honda
- Department of Premature and Neonatal Medicine, Iwaki City Medical Center, Fukushima, Japan
| | - Hajime Maeda
- Department of Pediatrics, Fukushima Medical University, Fukushima, Japan
| | - Maki Sato
- Department of Pediatrics, Fukushima Medical University, Fukushima, Japan
| | - Hajime Nakano
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Mitsuaki Hosoya
- Department of Pediatrics, Fukushima Medical University, Fukushima, Japan
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Vázquez Gómez F, Díaz Ruiz L, Bergón Sendín E, Barceló Mendiguchía A, Tejada Palacios P. [Laser therapy in ocular involvement after diagnosis of incontinentia pigmenti in a child]. ARCH ARGENT PEDIATR 2019; 117:e252-e256. [PMID: 31063312 DOI: 10.5546/aap.2019.e252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 12/06/2018] [Indexed: 11/12/2022]
Abstract
Incontinentia pigmenti is a rare neurocutaneous disorder with a frequency of 1 in 40,000 newborn; it is associated with mutations in IKBKG gene in Xq28, inherited as an X-linked dominant trait. Clinical manifestations detected since the newborn period are highly variable, with skin, teeth, eyes, and nervous system manifestations, and each with a characteristic differential diagnosis. We present a pediatric patient diagnosed with incontinentia pigmenti at the first week of life. In the initial ophthalmologic evaluation, retinal vascular lesions were observed. The outcomes of laser treatment of the ischemic peripheral retina were good and resulted in stability of vision.
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Affiliation(s)
| | - Laura Díaz Ruiz
- Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, España
| | - Elena Bergón Sendín
- Unidad de Neonatologia, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - Pilar Tejada Palacios
- Sección de Oftalmología Pediátrica. Hospital Universitario 12 de Octubre, Madrid, España
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Affiliation(s)
- Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Niharika Singh
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ekta Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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21
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Ocaña Jaramillo S, Del Boz J, Vera Casaño Á. [Incontinentia pigmenti. A descriptive study of experience in two different hospitals]. An Pediatr (Barc) 2019; 92:3-12. [PMID: 31109788 DOI: 10.1016/j.anpedi.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/18/2019] [Accepted: 04/12/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Incontinentia pigmenti is a rare genodermatosis of inheritance linked to the Xchromosome that affects tissues derived from ectoderm. The aim of the study is to review, as completely as possible, the cases diagnosed in paediatric patients in two hospitals. MATERIAL AND METHODS A retrospective cross-sectional study was carried out, using the clinical, analytical, radiological, and genetic data of paediatric patients diagnosed with incontinentia pigmenti from 2004 to 2018. The data collected were analysed and evaluated at a multidisciplinary level. RESULTS A total of thirteen patients diagnosed with incontinentia pigmenti were included in the study. All of them were female. A genetic study was performed on 11 patients, which confirmed findings compatible with incontinentia pigmenti in 10 of them. Extracutaneous involvement associated with the disease was observed at neurological level (radiological findings in 6 cases, and clinical expression in 3 of them), ophthalmological level (4 cases), dental level (7 cases), and haematological level (4 cases). CONCLUSIONS A presentation is given of the most complete study published so far of incontinentia pigmenti in Spain. In this study, the results of the disease manifestations were similar to the largest case series published internationally, which reinforces the importance of a multidisciplinary study and follow-up.
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Affiliation(s)
| | - Javier Del Boz
- Departamento de Dermatología, Hospital Costa del Sol, Marbella, Málaga, España
| | - Ángel Vera Casaño
- Departamento de Dermatología, Hospital Materno Infantil, Málaga, España
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22
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Wang X, Liang JH. [Treatment of retinopathy of incontinentia pigmenti by anti-vascular endothelial growth factor]. Zhonghua Yan Ke Za Zhi 2019; 55:294-301. [PMID: 30982292 DOI: 10.3760/cma.j.issn.0412-4081.2019.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the treatment of retinopathy of incontinentia pigmenti by anti-vascular endothelial growth factor. Methods: Retrospective study of 5 patients(8 eyes) diagnosed retinopathy of incontinentia pigmenti from 2005 to 2017, including 0 males and 5 females (8 eyes involved) with an average age of 2.4 months(range, 1-5 months). Medical history and family history were recorded in detail for all children. We did the examination of anterior segment of the eyeball, vitreous body,fundus and intraocular pressure for the 5 patients(8eyes).What's more,wo also took pictures for fundus with the machine of Retcam. Fundus fluorescence angiography (FFA) was performed in 2 patients(4 eyes). Different surgical methods were selected according to the specific conditions of the eye and postoperative were observed. Results: At the time of initial diagnosis, preretinal hemorrhage did not affect the macular region in 3 cases (5 eyes), pre retinal hemorrhage affected the macular region in 1 case(1 eye), the retinal neovascularization in 3 cases(5 eyes), the retinal detachment in 2 cases(2 eyes), and nonvascular zone of peripheral retinal in 5cases(8 eyes). Treatment and drug selection: 3 cases(5 eyes) were treated with injection anti-VEGF drug into vitreous body cavity, 1 case(1 eye) was treated with injection anti-VEGF drug into vitreous body cavity plus laser photocoagulation, 1 case(1 eye) was treated with anti-VEGF drugs plus vitrectomy. 1 case(1 eye) was treated with anti-VEGF drugs plus retinal cryotherapy and sclera bucking. In patients of injection anti-VEGF drug into vitreous body cavity, 2 cases(3 eyes) were given a single dose and 1 case (2 eyes) was given a repeated dose. Drug selection: 4 cases(6 eyes) ranibizumab injection (injection dose 0.025 ml), 1 case (2 eyes)conbercept injection (injection dose 0.025 ml). To follow-up date, etina was flat in 4 patients (7 eyes), epiretinal membrane in 2 patients(2 eyes), retinal detachment in 1 patient(1 eye). Conclusions: The efficacy of anti-vascular endothelial growth factor in the treatment of retinopathy of incontinentia pigmenti was prelininarily confimed.However,the optimal use timing,dosage,local and systemic safety issues were needed to be further studied. (Chin J Ophthalmol, 2019, 55:294-301).
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Frost M, Tencerova M, Andreasen CM, Andersen TL, Ejersted C, Svaneby D, Qui W, Kassem M, Zarei A, McAlister WH, Veis DJ, Whyte MP, Frederiksen AL. Absence of an osteopetrosis phenotype in IKBKG (NEMO) mutation-positive women: A case-control study. Bone 2019; 121:243-254. [PMID: 30659980 PMCID: PMC6457251 DOI: 10.1016/j.bone.2019.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/12/2018] [Accepted: 01/14/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND NF-κB essential modulator (NEMO), encoded by IKBKG, is necessary for activation of the ubiquitous transcription factor nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB). Animal studies suggest NEMO is required for NF-κB mediated bone homeostasis, but this has not been thoroughly studied in humans. IKBKG loss-of-function mutation causes incontinentia pigmenti (IP), a rare X-linked disease featuring linear hypopigmentation, alopecia, hypodontia, and immunodeficiency. Single case reports describe osteopetrosis (OPT) in boys carrying hypomorphic IKBKG mutations. METHOD We studied the bone phenotype in women with IP with evaluation of radiographs of the spine and non-dominant arm and leg; lumbar spine and femoral neck aBMD using DXA; μ-CT and histomorphometry of trans-iliac crest biopsy specimens; bone turnover markers; and cellular phenotype in bone marrow skeletal (stromal) stem cells (BM-MSCs) in a cross-sectional, age-, sex-, and BMI-matched case-control study. X-chromosome inactivation was measured in blood leucocytes and BM-MSCs using a PCR method with methylation of HpaII sites. NF-κB activity was quantitated in BM-MSCs using a luciferase NF-κB reporter assay. RESULTS Seven Caucasian women with IP (age: 24-67 years and BMI: 20.0-35.2 kg/m2) and IKBKG mutation (del exon 4-10 (n = 4); c.460C>T (n = 3)) were compared to matched controls. The IKBKG mutation carriers had extremely skewed X-inactivation (>90:10%) in blood, but not in BM-MSCs. NF-κB activity was lower in BM-MSCs from IKBKG mutation carriers (n = 5) compared to controls (3094 ± 679 vs. 5422 ± 1038/μg protein, p < 0.01). However, no differences were identified on skeletal radiographics, aBMD, μ-architecture of the iliac crest, or bone turnover markers. The IKBKG mutation carriers had a 1.7-fold greater extent of eroded surfaces relative to osteoid surfaces (p < 0.01), and a 2.0-fold greater proportion of arrested reversal surface relative to active reversal surface (p < 0.01). CONCLUSION Unlike mutation-positive males, the IKBKG mutation-positive women did not manifest OPT.
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Affiliation(s)
- Morten Frost
- Department of Clinical Research, Faculty of Health, University of Southern Denmark (SDU), Winsløwparken 19. 3, DK-5000 Odense C, Denmark; Steno Diabetes Center Odense, Odense University Hospital (OUH), J.B. Winsløws Vej 4, DK-5000 Odense C, Denmark; Department of Endocrinology, Molecular Endocrinology Unit, OUH, J.B. Winsløws Vej 4, DK-5000 Odense C, Denmark.
| | - Michaela Tencerova
- Department of Endocrinology, Molecular Endocrinology Unit, OUH, J.B. Winsløws Vej 4, DK-5000 Odense C, Denmark.
| | - Christina M Andreasen
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery & Traumatology, OUH, J.B. Winsløws Vej 15, DK-5000 Odense C, Denmark; Department of Clinical Cell Biology, Vejle Hospital, Beridderbakken 4, DK-7100 Vejle, Denmark.
| | - Thomas L Andersen
- Department of Clinical Cell Biology, Vejle Hospital, Beridderbakken 4, DK-7100 Vejle, Denmark.
| | - Charlotte Ejersted
- Department of Endocrinology, Molecular Endocrinology Unit, OUH, J.B. Winsløws Vej 4, DK-5000 Odense C, Denmark.
| | - Dea Svaneby
- Department of Clinical Genetics, Vejle Hospital, Beridderbakken 4, DK-7100 Vejle, Denmark.
| | - Weimin Qui
- Department of Endocrinology, Molecular Endocrinology Unit, OUH, J.B. Winsløws Vej 4, DK-5000 Odense C, Denmark
| | - Moustapha Kassem
- Department of Endocrinology, Molecular Endocrinology Unit, OUH, J.B. Winsløws Vej 4, DK-5000 Odense C, Denmark.
| | - Allahdad Zarei
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA.
| | - William H McAlister
- Department of Pediatric Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine at St. Louis Children's Hospital, St. Louis, MO, USA.
| | - Deborah J Veis
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO, USA; Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA.
| | - Michael P Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO, USA; Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA.
| | - Anja L Frederiksen
- Department of Clinical Research, Faculty of Health, University of Southern Denmark (SDU), Winsløwparken 19. 3, DK-5000 Odense C, Denmark; Department of Clinical Genetics, Odense University Hospital, J.B. Winsløws Vej 4, DK-5000 Odense C, Denmark.
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Sun S, Li F, Liu Y, Qu H, Wong SW, Zeng L, Yu M, Feng H, Liu H, Han D. A novel inhibitor of nuclear factor kappa-B kinase subunit gamma mutation identified in an incontinentia pigmenti patient with syndromic tooth agenesis. Arch Oral Biol 2019; 101:100-107. [PMID: 30913450 DOI: 10.1016/j.archoralbio.2019.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/14/2019] [Accepted: 03/16/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To explore the gene mutation in an incontinentia pigmenti (IP) patient with syndromic tooth agenesis. METHODS Long-range polymerase chain reaction (PCR) and Sanger sequencing were used to detect inhibitor of nuclear factor kappa-B kinase subunit gamma (IKBKG) mutation in the IP patient. We used the nuclear factor kappa B (NF-κB) reporter gene to assess activation of NF-κB, after transfecting an empty vector, wild-type, or mutant NF-κB essential modulator (NEMO) plasmid into IKBKG-deficient HEK293T cells, respectively. Furthermore, we performed immunoprecipitation and immunoblotting to describe the polyubiquitination of NEMO. Lastly, we detected the interactions between mutant NEMO and I kappa B kinase alpha (IKKα), I kappa B kinase beta (IKKβ), TNF receptor associated factor 6 (TRAF6), HOIL-1-interacting protein (HOIP), hemo-oxidized iron regulatory protein 2 ligase 1 (HOIL-1), and SHANK-associated RH domain interactor (SHARPIN). RESULTS A de novo nonsense mutation in IKBKG (c.924C > G; p.Tyr308*) was observed. The Tyr308* mutation inhibited activation of the NF-κB pathway by reducing K63-linked polyubiquitination and linear polyubiquitination. The mutant NEMO was not able to interact with TRAF6, HOIL-1, or SHARPIN. CONCLUSIONS We identified a novel nonsense IKBKG mutation (c.924C > G; p.Tyr308*) in an IP patient with syndromic tooth agenesis. This research enriches the mutation spectrum of the IKBKG gene.
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Affiliation(s)
- Shichen Sun
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing 100081, PR China
| | - Fang Li
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing 100081, PR China
| | - Yang Liu
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing 100081, PR China
| | - Hong Qu
- Center for Bioinformatics, State Key Laboratory of Protein and Plant Gene Research, College of Life Sciences, Peking University, Beijing 100871, PR China
| | - Sing-Wai Wong
- Oral and Craniofacial Biomedicine Curriculum, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Li Zeng
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing 100081, PR China
| | - Miao Yu
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing 100081, PR China
| | - Hailan Feng
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing 100081, PR China
| | - Haochen Liu
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing 100081, PR China.
| | - Dong Han
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing 100081, PR China.
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25
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Affiliation(s)
- Indar Kumar Sharawat
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lokesh Saini
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Dipankar De
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Cammarata-Scalisi F, Fusco F, Ursini MV. Incontinentia Pigmenti. Actas Dermosifiliogr (Engl Ed) 2019; 110:273-8. [PMID: 30660327 DOI: 10.1016/j.ad.2018.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/04/2018] [Accepted: 10/13/2018] [Indexed: 12/11/2022] Open
Abstract
Incontinentia pigmenti (Bloch-Sulzberger syndrome) is a rare neuroectodermal dysplasia. It is an X-linked dominant disorder caused by mutations in the IKBKG/NEMO gene on Xq28. Approximately 80% of patients have a deletion of exons 4 to 10. Incontinentia pigmenti has an estimated incidence of 0.7 cases per 100,000 births. In hemizygous males, it is usually lethal, while in females, it has a wide spectrum of clinical manifestations. Incontinentia pigmenti is a multisystemic disease that invariably features skin changes. These changes are the main diagnostic criteria and they evolve in 4 stages, in association with other abnormalities affecting the central nervous system, eyes, teeth, mammary glands, hair, nails, skin, and other parts of the body. The aim of this brief review is to highlight the clinical features of this genodermatosis and underline the importance of case-by-case interdisciplinary management, including genetic counseling.
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Abstract
Incontinentia pigmenti (IP) is a rare X-linked dominant disease that affects the ectodermal tissues. It is associated with a whorled pattern of scarring alopecia, which is possibly underreported. This scarring alopecia could be used as a marker to identify adult women affected with IP as older patients may have minimal cutaneous manifestations. We report an unusual case of an 8-year-old girl who had recurrent inflammatory stage IP and later developed whorled scarring alopecia in the vertex of the scalp.
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Affiliation(s)
- Urvi Popli
- Departments of Dermatology, Wrexham Maelor Hospital, Wrexham, Wales, UK
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28
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Seo MY, You SJ, Kim SH, Cho WH, Chae JH. A 6-Month-Old Girl with Incontinentia Pigmenti Presenting as Status Epilepticus. J Epilepsy Res 2017; 7:118-120. [PMID: 29344471 PMCID: PMC5767489 DOI: 10.14581/jer.17019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 11/13/2017] [Indexed: 11/03/2022] Open
Abstract
Incontinentia pigmenti (IP) is an uncommon neurocutaneous syndrome. Its initial diagnosis is based primarily on characteristic papulovesicular skin lesions and early-onset neonatal seizures. In contrast to typical early neurologic manifestations, we encountered a normally developed 6-month-old female patient with hyperpigmented whorls on her body. Following respiratory syncytial virus infection and fever, the patient exhibited status epilepticus. Brain magnetic resonance imaging studies of the patient were compatible with the findings of acute encephalopathy in IP. Genetic analysis showed an 11.7 kb deletion within the gene encoding inhibitor of kappa-B kinase gamma. The patient was treated with anticonvulsants and subsequently reached expected developmental milestones after discharge. These findings indicate that when a patient presents with status epilepticus, meticulous examination for skin lesions should be performed to determine whether the patient has a neurocutaneous syndrome, such as IP.
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Affiliation(s)
- Moon Young Seo
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Su Jeong You
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Soung Hee Kim
- Department of Radiology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Woo Ho Cho
- Department of Radiology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jong Hee Chae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
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29
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Weiss SJ, Srinivasan A, Klufas MA, Shields CL. Incontinentia pigmenti in a child with suspected retinoblastoma. Int J Retina Vitreous 2017; 3:34. [PMID: 28932485 PMCID: PMC5603187 DOI: 10.1186/s40942-017-0088-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/23/2017] [Accepted: 08/01/2017] [Indexed: 12/03/2022] Open
Abstract
Background Incontinentia pigmenti is a rare X-linked dominant syndrome caused by mutation in the NEMO/IKKgamma gene, and characterized by a spectrum of cutaneous, ocular, neurologic and dental abnormalities. In the eye, findings include retinal vascular non-perfusion, occasionally with traction retinal detachment, retinal fibrosis, and retinal pigment epithelium defects. These findings can resemble retinoblastoma, especially when vitreoretinal fibrosis produces leukocoria. Case report A 2-month-old girl born full-term presented with leukocoria, suspicious for retinoblastoma. She was found to have an ischemic retrolental fibrovascular retinal detachment. In addition, there was linear cutaneous hyperpigmentation, diagnostic of incontinentia pigmenti. Conclusions Retinoblastoma can be a challenge to diagnose. There are numerous simulating lesions that can present with leukocoria and retinal detachment, including incontinentia pigmenti. Recognition of the cutaneous features of incontinentia pigmenti contributes to early detection of related ophthalmologic, neurologic and dental abnormalities.
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Affiliation(s)
- Stephanie J Weiss
- Ocular Oncology Service, Suite 1440, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA 19107 USA.,Ophthalmology Department, Drexel University College of Medicine, Philadelphia, PA USA
| | - Archana Srinivasan
- Ocular Oncology Service, Suite 1440, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA 19107 USA
| | - Michael A Klufas
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA USA
| | - Carol L Shields
- Ocular Oncology Service, Suite 1440, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA 19107 USA
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30
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Bal E, Laplantine E, Hamel Y, Dubosclard V, Boisson B, Pescatore A, Picard C, Hadj-Rabia S, Royer G, Steffann J, Bonnefont JP, Ursini VM, Vabres P, Munnich A, Casanova JL, Bodemer C, Weil R, Agou F, Smahi A. Lack of interaction between NEMO and SHARPIN impairs linear ubiquitination and NF-κB activation and leads to incontinentia pigmenti. J Allergy Clin Immunol 2017; 140:1671-1682.e2. [PMID: 28249776 DOI: 10.1016/j.jaci.2016.11.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 10/31/2016] [Accepted: 11/21/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Incontinentia pigmenti (IP; MIM308300) is a severe, male-lethal, X-linked, dominant genodermatosis resulting from loss-of-function mutations in the IKBKG gene encoding nuclear factor κB (NF-κB) essential modulator (NEMO; the regulatory subunit of the IκB kinase [IKK] complex). In 80% of cases of IP, the deletion of exons 4 to 10 leads to the absence of NEMO and total inhibition of NF-κB signaling. Here we describe a new IKBKG mutation responsible for IP resulting in an inactive truncated form of NEMO. OBJECTIVES We sought to identify the mechanism or mechanisms by which the truncated NEMO protein inhibits the NF-κB signaling pathway. METHODS We sequenced the IKBKG gene in patients with IP and performed complementation and transactivation assays in NEMO-deficient cells. We also used immunoprecipitation assays, immunoblotting, and an in situ proximity ligation assay to characterize the truncated NEMO protein interactions with IKK-α, IKK-β, TNF receptor-associated factor 6, TNF receptor-associated factor 2, receptor-interacting protein 1, Hemo-oxidized iron regulatory protein 2 ligase 1 (HOIL-1), HOIL-1-interacting protein, and SHANK-associated RH domain-interacting protein. Lastly, we assessed NEMO linear ubiquitination using immunoblotting and investigated the formation of NEMO-containing structures (using immunostaining and confocal microscopy) after cell stimulation with IL-1β. RESULTS We identified a novel splice mutation in IKBKG (c.518+2T>G, resulting in an in-frame deletion: p.DelQ134_R256). The mutant NEMO lacked part of the CC1 coiled-coil and HLX2 helical domain. The p.DelQ134_R256 mutation caused inhibition of NF-κB signaling, although the truncated NEMO protein interacted with proteins involved in activation of NF-κB signaling. The IL-1β-induced formation of NEMO-containing structures was impaired in fibroblasts from patients with IP carrying the truncated NEMO form (as also observed in HOIL-1-/- cells). The truncated NEMO interaction with SHANK-associated RH domain-interacting protein was impaired in a male fetus with IP, leading to defective linear ubiquitination. CONCLUSION We identified a hitherto unreported disease mechanism (defective linear ubiquitination) in patients with IP.
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Affiliation(s)
- Elodie Bal
- INSERM U1163 Paris-Descartes University, Sorbonne Paris Cité, IMAGINE Institute, Necker Hospital Enfants-Malades, Paris, France
| | - Emmanuel Laplantine
- Laboratory of Signaling and Pathogenesis, CNRS UMR 3691, Pasteur Institute, Paris, France
| | - Yamina Hamel
- INSERM U1163 Paris-Descartes University, Sorbonne Paris Cité, IMAGINE Institute, Necker Hospital Enfants-Malades, Paris, France
| | - Virginie Dubosclard
- Departments of Cell Biology and Infection and of Structural Biology and Chemistry, URA 2185, Pasteur Institute, Paris, France
| | - Bertrand Boisson
- Rockefeller Branch, St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller University, New York, NY; Necker Branch, Laboratory of Human Genetics of Infectious Diseases, UMR 1163, Paris-Descartes University, Sorbonne Paris Cité, IMAGINE Institute, Necker Hospital Enfants-Malades, Paris, France
| | - Alessandra Pescatore
- Institute of Genetics and Biophysics "Adriano Buzzati-Traverso" (CNR), Naples, Italy
| | - Capucine Picard
- Rockefeller Branch, St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller University, New York, NY; Necker Branch, Laboratory of Human Genetics of Infectious Diseases, UMR 1163, Paris-Descartes University, Sorbonne Paris Cité, IMAGINE Institute, Necker Hospital Enfants-Malades, Paris, France; Immunodeficiency Study Center, Necker Children's Hospital, Paris, France
| | - Smaïl Hadj-Rabia
- INSERM U1163 Paris-Descartes University, Sorbonne Paris Cité, IMAGINE Institute, Necker Hospital Enfants-Malades, Paris, France; Department of Dermatology, Referral Center for Genodermatoses (MAGEC), Imagine Institute, Necker-Enfants Malades Hospital (AP-HP), Paris, France
| | - Ghislaine Royer
- INSERM U1163 Paris-Descartes University, Sorbonne Paris Cité, IMAGINE Institute, Necker Hospital Enfants-Malades, Paris, France
| | - Julie Steffann
- INSERM U1163 Paris-Descartes University, Sorbonne Paris Cité, IMAGINE Institute, Necker Hospital Enfants-Malades, Paris, France
| | - Jean-Paul Bonnefont
- INSERM U1163 Paris-Descartes University, Sorbonne Paris Cité, IMAGINE Institute, Necker Hospital Enfants-Malades, Paris, France
| | - Valeria M Ursini
- Institute of Genetics and Biophysics "Adriano Buzzati-Traverso" (CNR), Naples, Italy
| | - Pierre Vabres
- Department of Dermatology, Dijon CHU, Medicine Faculty and Bourgogne University, EA427 Genetic of Development Abonomalies, Bocage Hospital, Dijon, France
| | - Arnold Munnich
- INSERM U1163 Paris-Descartes University, Sorbonne Paris Cité, IMAGINE Institute, Necker Hospital Enfants-Malades, Paris, France
| | - Jean-Laurent Casanova
- Rockefeller Branch, St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller University, New York, NY; Necker Branch, Laboratory of Human Genetics of Infectious Diseases, UMR 1163, Paris-Descartes University, Sorbonne Paris Cité, IMAGINE Institute, Necker Hospital Enfants-Malades, Paris, France; Pediatric Hematology, Immunology & Rheumatology Unit, Necker Children's Hospital, Paris, France
| | - Christine Bodemer
- INSERM U1163 Paris-Descartes University, Sorbonne Paris Cité, IMAGINE Institute, Necker Hospital Enfants-Malades, Paris, France; Department of Dermatology, Referral Center for Genodermatoses (MAGEC), Imagine Institute, Necker-Enfants Malades Hospital (AP-HP), Paris, France
| | - Robert Weil
- Laboratory of Signaling and Pathogenesis, CNRS UMR 3691, Pasteur Institute, Paris, France
| | - Fabrice Agou
- Departments of Cell Biology and Infection and of Structural Biology and Chemistry, URA 2185, Pasteur Institute, Paris, France
| | - Asma Smahi
- INSERM U1163 Paris-Descartes University, Sorbonne Paris Cité, IMAGINE Institute, Necker Hospital Enfants-Malades, Paris, France.
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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]. Bol Med Hosp Infant Mex 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Maahs MAP, Kiszewski AE, Rosa RFM, Maria FDS, Prates FB, Zen PRG. Cephalometric skeletal evaluation of patients with Incontinentia Pigmenti. J Oral Biol Craniofac Res 2014; 4:88-93. [PMID: 25737924 PMCID: PMC4252390 DOI: 10.1016/j.jobcr.2014.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 05/20/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the skeletal characteristics of patients with the rare genetic disease of Incontinentia Pigmenti, by lateral cephalometric analysis on the antero-posterior plane and by frontal cephalometric analysis on the horizontal plane. METHODS Lateral skeletal cephalometric analyses were performed according to Steiner for evaluation of antero-posterior direction, and frontal skeletal cephalometric analyses according to Ricketts for evaluation of horizontal direction in 9 patients with IP. Left and right facial widths at the level of the zygomatic arch were also evaluated. The Student t-test was used for paired to a 5% level of significance data. RESULTS The lateral skeletal cephalometric findings were not statistically significant, but the Class II was the most frequent finding (44.4%), followed by Class III (33.3%) and Class I (22.2%). The right maxillo-mandibular width was significantly lower than normal values, and the right facial width was significantly higher than the left, at the level of the zygomatic arch. CONCLUSIONS Patients with IP showed more skeletal discrepancies of Class II and III than Class I malocclusion, and had significant horizontal facial skeletal asymmetries. This should alert health professionals to route these patients for orthodontic assessment and possible therapeutic interventions. However, larger samples are needed to better elucidate if these cephalometric findings can be specifically related to IP.
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Affiliation(s)
| | - Ana Elisa Kiszewski
- Pediatric Dermatologist and Adjunct Professor of Dermatology at UFCSPA, Porto Alegre, RS, Brazil
| | | | | | - Frederico Ballvé Prates
- Specialist in Dental Radiology and Imaging through São Leopoldo Mandic (Sobracursos), Porto Alegre, RS, Brazil
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Ojha R, Villarreal D, Coughtrey H. Neonatal presentation of incontinentia pigmenti with a family history extending over four generations--a case report. J Neonatal Perinatal Med 2014; 7:151-5. [PMID: 25104119 DOI: 10.3233/npm-1475413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of Incontinentia pigmenti (IP). A day 2 female presented to the special care nursery with seizures. EEG showed multifocal epileptiform discharges and cranial MRI revealed extensive cerebral infarction. A rash appeared shortly after birth. Eye examination revealed changes of IP. There is a strong family history of IP. Genetic testing excluded the most common mutation. Follow-up reveals significant development delay.
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Affiliation(s)
- R Ojha
- Sydney Medical School - Nepean, The University of Sydney, Discipline of Pediatrics, Nepean Hospital, NSW, Australia Suchlich School of Medicine & Dentistry, Discipline of Pediatrics, Western University, London, ON, Canada
| | - D Villarreal
- Sydney Medical School - Nepean, The University of Sydney, Discipline of Pediatrics, Nepean Hospital, NSW, Australia
| | - H Coughtrey
- Sydney Medical School - Nepean, The University of Sydney, Discipline of Pediatrics, Nepean Hospital, NSW, Australia
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Wang Y, Chen Y, Wang Q, Wang G, Guo C, Wang F, Deng X, Wang W. A 14-year-old girl with an unusual combination of incontinentia pigmenti and conversion disorder. Int J Clin Exp Med 2013; 6:1006-1009. [PMID: 24260612 PMCID: PMC3832343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 10/21/2013] [Indexed: 06/02/2023]
Abstract
Incontinentia pigmenti is a rare X-linked neurological-skin genetic disease. Some studies have shown that about 30~40% of patients with IP have varying symptoms of eye/central nervous system which are the major causes of disability. Conversion disorder is one of the most common mental diseases in children and may exhibit the single or multiple neurological symptoms. In this paper, we will report a child with new and rare incontinentia pigmenti accompanied by conversion disorder and explore the relationship of this rare combination.
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Affiliation(s)
- Yan Wang
- Department of Neurology, Shanghai First People’s Hospital, Shanghai Jiaotong UniversityShanghai 200080, China
| | - Yihui Chen
- Department of Ophthalmology, Shanghai Tenth People’s Hospital, Tongji UniversityShanghai 200072, China
| | - Qiaoshu Wang
- Department of Neurology, Shanghai First People’s Hospital, Shanghai Jiaotong UniversityShanghai 200080, China
| | - Guodong Wang
- Department of Neurology, Shanghai First People’s Hospital, Shanghai Jiaotong UniversityShanghai 200080, China
| | - Chunni Guo
- Department of Neurology, Shanghai First People’s Hospital, Shanghai Jiaotong UniversityShanghai 200080, China
| | - Feng Wang
- Department of Neurology, Shanghai First People’s Hospital, Shanghai Jiaotong UniversityShanghai 200080, China
| | - Xiaolei Deng
- Department of Neurology, Shanghai First People’s Hospital, Shanghai Jiaotong UniversityShanghai 200080, China
| | - Weizhen Wang
- Department of Neurology, Shanghai First People’s Hospital, Shanghai Jiaotong UniversityShanghai 200080, China
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Beccastrini E, Baldereschi G, D’Elios MM, Emmi L. Arterial occlusion mimicking vasculitis in a patient with incontinentia pigmenti. Auto Immun Highlights 2013; 4:63-5. [PMID: 26000144 PMCID: PMC4389049 DOI: 10.1007/s13317-013-0050-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 02/09/2013] [Indexed: 11/25/2022]
Abstract
A large number of diseases can mimic a vasculitis. The diagnosis can be challenging due to the similarity with several diseases that have a different pathogenesis. As reported in the literature, incontinentia pigmenti (IP), a rare genetic disorder, can present vascular alterations on eye, brain and lung. We report a case of peripheral arterial disease in a patient with IP, suggesting further vascular localizations of the disease.
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Affiliation(s)
- E. Beccastrini
- Department of Biomedicine, Patologia Medica, Center for Systemic Autoimmune Diseases, Lupus Clinic, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy
| | - G. Baldereschi
- Department of Heart and Vessels, Careggi University Hospital, Florence, Italy
| | - M. M. D’Elios
- Department of Biomedicine, Patologia Medica, Center for Systemic Autoimmune Diseases, Lupus Clinic, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy
| | - L. Emmi
- Department of Biomedicine, Patologia Medica, Center for Systemic Autoimmune Diseases, Lupus Clinic, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy
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Chung WK, Lee DW, Chang SE, Lee MW, Choi JH, Moon KC. A case of incontinentia pigmenti associated with multiorgan abnormalities. Ann Dermatol 2009; 21:56-9. [PMID: 20548858 DOI: 10.5021/ad.2009.21.1.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Accepted: 08/05/2008] [Indexed: 11/08/2022] Open
Abstract
Incontinentia pigmenti is a systemic disorder affecting the skin, teeth, eyes, nervous tissue, hair, nails, musculoskeletal system, and heart. We describe an 11-month-old girl with incontinentia pigmenti associated with a ventricular septal defect, left hemiatrophy, hemangiomas, an abnormal labial frenum, and spastic cerebral palsy manifested as left hemiplegia and developmental delay. We believe this patient illustrates that incontinentia pigmenti is a systemic disorder necessitating a multidisciplinary approach to management.
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Affiliation(s)
- Woon-Kyong Chung
- Department of Dermatology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Song JY, Na CH, Chung BS, Choi KC, Shin BS. A Case of a Surviving Male Infant with Incontinentia Pigmenti. Ann Dermatol 2008; 20:134-7. [PMID: 27303177 DOI: 10.5021/ad.2008.20.3.134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 03/12/2008] [Indexed: 11/08/2022] Open
Abstract
Incontinentia pigmenti (Bloch-Sulzberger's disease) is an X-linked dominantly inherited disorder which is usually lethal in hemizygous males, but rarely found in male infants. It can be explained by the presence of an extra X chromosome (Klinefelter's syndrome), hypomorphic mutations, and somatic mosaicism. We herein report a rare case of incontinentia pigmenti with typical course of skin manifestation in normal karyotype (46, XY) male infant.
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Affiliation(s)
- Ji Young Song
- Department of Dermatology, Chosun University Medical School, Gwangju, Korea
| | - Chan Ho Na
- Department of Dermatology, Chosun University Medical School, Gwangju, Korea
| | - Byoung Soo Chung
- Department of Dermatology, Chosun University Medical School, Gwangju, Korea
| | - Kyu Cherl Choi
- Department of Dermatology, Chosun University Medical School, Gwangju, Korea
| | - Bong Seok Shin
- Department of Dermatology, Chosun University Medical School, Gwangju, Korea
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