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Gunasekaran PK, Jindal P, Rajial T, Vyas V, Singh K. Down-Klinefelter Syndrome With Concurrent Double Aneuploidy in an Indian Child. Cureus 2024; 16:e55847. [PMID: 38590493 PMCID: PMC11001255 DOI: 10.7759/cureus.55847] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/10/2024] Open
Abstract
The genetics of Down syndrome (DS) and Klinefelter syndrome (KS) are a nondisjunction of autosomal and sex chromosomes, respectively, resulting in aneuploidies. Less than 70 cases of concurrent Down-Klinefelter syndrome (DS-KS) have been reported in the literature. We report the case of a five-month-old Indian child with a rare double aneuploidy resulting in DS-KS. A five-month-old boy born to non-consanguineously married parents presented with failure to thrive and dysmorphic facies. The family history was unremarkable. On examination, he had an upward eye slant, a depressed nasal bridge, a horizontal crease in the left hand, and a sandal gap. A clinical diagnosis of the Down phenotype was considered. Karyotype analysis revealed the presence of double aneuploidy (48, XXY,+21) suggestive of DS-KS. Down-Klinefelter syndrome presents with the DS phenotype at birth, and the characteristic KS phenotype develops in early infancy and apparently manifests during puberty only. Early diagnosis is required for parental counseling and planning for future pregnancies. In children with a typical Down syndrome phenotype, chromosomal analysis is highly recommended. The diagnosis of DS-KS at the earliest has implications for these children's short-term and long-term outcomes. It helps in planning the subsequent pregnancy with appropriate genetic testing and counseling to avoid the risk of another child with trisomy.
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Affiliation(s)
| | - Pooja Jindal
- Pediatrics, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Tanuja Rajial
- Pediatrics, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Varuna Vyas
- Pediatrics, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Kuldeep Singh
- Pediatrics, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
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Mansour M, AlZoubi A, Zoukar S, Aljammal G, Makki R, Khaled NAH, Aletesh Y, Aljundi R, Mohammad Deeb A, Ajlouni MO. Double aneuploidy in a 2-month-old male with Edward syndrome and Klinefelter syndrome: a case report. Ann Med Surg (Lond) 2024; 86:489-496. [PMID: 38222680 PMCID: PMC10783209 DOI: 10.1097/ms9.0000000000001468] [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: 09/08/2023] [Accepted: 10/21/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction and importance Edward syndrome is a severe chromosomal defect that occurs as a result of non-disjunction through meiosis. It presents with cardiac septal defects, horseshoe kidneys, patent ductus arteriosus, central nervous system dysgenesis, distinctive craniofacial deformities, and overriding or overlapping fingers. Klinefelter syndrome (47, XXY) is found in 1 in 660 newborn males. It is considered to be one of the most common genetic causes of infertility. It manifests with small firm testes, androgen insufficiency, and azoospermia. Case presentation A 2-month-old male infant with a history of weakness in feeding, frequent convulsions, and an increase in cyanosis two days ago. There were multiple skeletal deformities and a tendency to spasm in the extremities, left ventricular atrophy, mitral atresia, atrial septal defect, ventricular septal defect with dilated right cavities, tricuspid valve regurgitation, pulmonary valve stenosis; and the aorta exits in the right ventricle. There is a widening of the subdural space, which was observed in the left frontal-parietal side with cortical atrophy in that area and a widening of the Sylvian fissure. A karyotype test confirmed the presence of Edward and Klinefelter syndromes. Clinical discussion Aneuploidy is a chromosomal issue characterized by an abnormal number of a chromosome copies. The coexistence of two aneuploidies is called "double aneuploidy" which is a rare occurrence. Herein, we report a case of a 2-month-old male with Edward syndrome and Klinefelter syndrome. Conclusion This publication aims to highlight the challenges in diagnosing and treating a complicated genetic disease.
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Affiliation(s)
- Marah Mansour
- Faculty of Medicine, Tartous University, Tartous
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Ahmed AlZoubi
- Faculty of Medicine, Yarmouk University, Irbid, Jordan
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Adeleke O, Elmufti H, Zhang J, Jagadesan B, Harsono M. Double Aneuploidy of Down Syndrome (Trisomy 21) and Jacobs Syndrome (Trisomy XYY) with Complete Tracheal Rings Deformity: Case Report and Literature Review. AJP Rep 2023; 13:e53-e60. [PMID: 37937269 PMCID: PMC10627712 DOI: 10.1055/s-0043-1774728] [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: 06/08/2023] [Accepted: 07/28/2023] [Indexed: 11/09/2023] Open
Abstract
Down syndrome (DS, trisomy 21) with an extra copy of chromosome 21 is one of the most common aneuploidies in humans. Jacobs syndrome or XYY syndrome (trisomy XYY) with an extra copy of sex chromosome Y is a rare sex chromosome trisomy in males. Double aneuploidy (DA) with an extra copy of chromosome 21 and sex chromosome Y is an extremely rare occurrence. Most trisomy 21 results from nondisjunction during maternal oocyte meiosis-I, whereas trisomy XYY is results from nondisjunction during paternal spermatocyte meiosis-I. We present a case of natural conception premature newborn of 30.4 weeks gestational age who had a DS facial phenotype with extensive syndactyly on both hands and feet. Other multisystem congenital anomalies were discovered, including mal-aligned perimembranous ventricular septal defect, bicuspid aortic valve, Dandy-Walker malformation's tetra-ventriculomegaly, and a rare complete tracheal rings deformity (CTRD) with trachea stenosis. Prenatal amniocentesis and postnatal chromosomal karyotyping analysis detected 48, XYY, + 21 nontranslocation trisomy 21, and free-lying Y chromosome without translocation. The existence of DA is rarely reported in literature reviews. In this review, we will discuss the characteristics of DS and Jacobs syndrome as well as the associated multiorgan malformation including the rare lethal CTRD.
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Affiliation(s)
- Omoloro Adeleke
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Tennessee Health Science Center, LeBonheur Children's Hospital, Memphis, Tennessee
| | - Hussein Elmufti
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Tennessee Health Science Center, LeBonheur Children's Hospital, Memphis, Tennessee
| | - Jie Zhang
- Division of Pediatric Pathology, Department of Pathology, University of Tennessee Health Science Center, LeBonheur Children's Hospital, Memphis, Tennessee
| | - Bhuvaneshwari Jagadesan
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Tennessee Health Science Center, LeBonheur Children's Hospital, Memphis, Tennessee
| | - Mimily Harsono
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Tennessee Health Science Center, LeBonheur Children's Hospital, Memphis, Tennessee
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Muacevic A, Adler JR, Al Agnam AA, Alibraheem AA, Bu Zaid HT. Rare Double Aneuploidy (Down-Klinefelter Syndrome): A Case Report. Cureus 2022; 14:e31330. [PMID: 36514585 PMCID: PMC9741132 DOI: 10.7759/cureus.31330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 11/12/2022] Open
Abstract
Double aneuploidies, such as Down syndrome and sex chromosome aneuploidies, are relatively rare. One rare form of double aneuploidy, Down-Klinefelter syndrome, is described here. The phenotypic characteristics of a three-year-old child showed the presence of features typical of Down syndrome. He had a global developmental delay, small testes, and diabetes mellitus by 18 months of age. Regardless of the presenting clinical features, karyotyping should be performed in all patients with suspected Down syndrome. In Down-Klinefelter syndrome, anticipatory phenotype goes beyond the sum of individual syndromic characteristics.
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Panigrahi I, Bhatt Y, Malik S, Kaur P, Kaur A. Clinical Profile of Indian Children with Down Syndrome. J Pediatr Genet 2021; 12:53-57. [PMID: 36684542 PMCID: PMC9848754 DOI: 10.1055/s-0041-1732475] [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: 02/09/2021] [Accepted: 06/15/2021] [Indexed: 01/25/2023]
Abstract
This retrospective study was performed on 208 patients with Down syndrome (DS) from heterogeneous ethnic population and admitted under Genetics Metabolic Unit. The aim of the study was to look for phenotypic variability and associated complications in children and adolescents with DS. The average age of the evaluated DS patients was 34 months. Cardiac anomalies were found in 128 (62%) of the 208 cases. Among the cardiac disorders, atrial septal defects accounted for 30% of cases. Other complications observed were hypothyroidism and developmental delay in around 31% cases and neonatal cholestasis in 14% cases. Also, we report two cases with Moya-Moya disease and one case with atlanto-axial dislocation.
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Affiliation(s)
- Inusha Panigrahi
- Department of Pediatrics, Genetic-Metabolic Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research, Chandigarh, India,Address for correspondence Inusha Panigrahi, MD, DM Department of Pediatrics, Genetic Metabolic Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research Chandigarh 160012India
| | - Yogita Bhatt
- Department of Pediatrics, Genetic-Metabolic Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Shivani Malik
- Department of Pediatrics, Genetic-Metabolic Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Parminder Kaur
- Department of Pediatrics, Genetic-Metabolic Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Anupriya Kaur
- Department of Pediatrics, Genetic-Metabolic Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Li X, Ju D, Shi Y, Li Y, Dong H, Huang J, Zhang Y. Fetal aneuploidy screening by non-invasive prenatal testing of maternal plasma DNA sequencing with "false negative" result due to confined placental mosaicism: A case report. Medicine (Baltimore) 2020; 99:e20848. [PMID: 32702826 PMCID: PMC7373535 DOI: 10.1097/md.0000000000020848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Non-invasive prenatal testing (NIPT) is an accurate screening method with high specificity and sensitivity and a low false-positive rate of trisomy 21, 18, and 13. However, false-negative NIPT results could also limit the clinical application of NIPT. PATIENT CONCERNS A 34-year-old primigravida woman who underwent NIPT at 16 + 3 weeks' gestation was identified as being at high risk for fetal trisomy X (47, XXX). Fetal cardiac defect and hand posture were observed during prenatal ultrasound examination at the 23rd week of gestation. DIAGNOSES Amniocentesis conducted at the 24th week of gestation. Fetal karyotyping and FISH identified karyotype 48, XXX, + 18, which indicated that the NIPT failed to detect trisomy 18 in this case. INTERVENTIONS The couple decided to terminate pregnancy at the 26th week of gestation and was willing to undergo further examinations. OUTCOMES Discordant results between fetus with trisomy 18 and placenta with mosaic T18 were further identified with massive parallel sequencing, which might be due to that the fetal cell-free DNA in maternal plasma for NIPT that was assessed principally originated from the trophoblast cells. LESSONS The presence of trisomy 18 mosaicism in the placenta might be the reason for the false-negative NIPT result in this case of double aneuploidy with 48, XXX, + 18, karyotype. Although the NIPT is a valuable screening method that has evident advantages in prenatal aneuploidy screening for certain chromosomal abnormalities compared to other methods, it is not a "diagnostic test" yet.
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Abstract
Chromosomal abnormalities are seen in nearly 1% of live born infants. We report a 5-year-old boy with the clinical features of Down syndrome, which is the most common human aneuploidy. Cytogenetic analysis showed a mosaicism for a double aneuploidy, Down syndrome and XYY. The karyotype was 47, XY,+21[19]/48, XYY,+21[6]. ish XYY (DXZ1 × 1, DYZ1 × 2). Mosaic double aneuploidies are very rare and features of only one of the aneuploidies may predominate in childhood. Cytogenetic analysis is recommended even if the typical features of a recognized aneuploidy are present so that any associated abnormality may be detected. This will enable early intervention to provide the adequate supportive care and management.
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Affiliation(s)
- Mayur Parihar
- Cytogenetics Unit, Christian Medical College, Vellore, Tamil Nadu, India
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Gerretsen MF, Peelen W, Rammeloo LAJ, Koolbergen DR, Hruda J. Double aortic arch with double aneuploidy--rare anomaly in combined Down and Klinefelter syndrome. Eur J Pediatr 2009; 168:1479-81. [PMID: 19263078 PMCID: PMC2772960 DOI: 10.1007/s00431-009-0958-4] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 02/13/2009] [Indexed: 12/01/2022]
Abstract
A 14-month-old boy with double aneuploidy and a double aortic arch suffered from frequently recurrent severe feeding and respiratory problems. Chromosomal analysis showed a 48,XXY + 21 karyotype: a double aneuploidy of Down syndrome (DS) and Klinefelter syndrome (KS). Only four cases of double aneuploidy (DS + KS) associated with congenital heart defects have been published of which none had a double aortic arch. Our case report should draw attention to the possibility of a double aortic arch in patients with severe feeding and respiratory problems and a double aneuploidy.
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Affiliation(s)
- Maaike F. Gerretsen
- Department of Pediatric Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Willem Peelen
- Department of Pediatrics, St. Jansdal Hospital, Harderwijk, The Netherlands
| | - Lukas A. J. Rammeloo
- Department of Pediatric Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - David R. Koolbergen
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Jaroslav Hruda
- Department of Pediatric Cardiology, VU University Medical Center, Amsterdam, The Netherlands
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