Krøigård Anne Bruun, Clemmensen Ole, Gjørup Hans, Hertz Jens Michael, Bygum Anette
Department of Clinical Genetics, Odense University Hospital, Sdr. Boulevard 29, DK-5000, Odense, Denmark.
Department of Clinical Pathology, Odense University Hospital, Odense, Denmark.
BMC Dermatol. 2016 Mar 10;16:3. doi: 10.1186/s12895-016-0040-7.
BACKGROUND: Odonto-onycho-dermal dysplasia (OODD) is a rare form of ectodermal dysplasia characterized by severe oligodontia, onychodysplasia, palmoplantar hyperkeratosis, dry skin, hypotrichosis, and hyperhidrosis of the palms and soles. The ectodermal dysplasias resulting from biallelic mutations in the WNT10A gene result in highly variable phenotypes, ranging from isolated tooth agenesis to OODD and Schöpf-Schulz-Passarge syndrome (SSPS). CASE PRESENTATION: We identified a female patient, with consanguineous parents, who was clinically diagnosed with OODD. Genetic testing showed that she was homozygous for a previously reported pathogenic mutation in the WNT10A gene, c.321C > A, p.Cys107*. The skin and nail abnormalities were for many years interpreted as psoriasis and treated accordingly. A thorough clinical examination revealed hypotrichosis and hyperhidrosis of the soles and dental examination revealed agenesis of permanent teeth except the two maxillary central incisors. Skin biopsies from the hyperkeratotic palms and soles showed the characteristic changes of eccrine syringofibroadenomatosis, which has been described in patients with ectodermal dysplasias. Together with a family history of tooth anomalies, this lead to the clinical suspicion of a hereditary ectodermal dysplasia. CONCLUSION: This case illustrates the challenges of diagnosing ectodermal dysplasia like OODD and highlights the relevance of interdisciplinary cooperation in the diagnosis of rare conditions.
背景:牙-甲-皮发育异常(OODD)是一种罕见的外胚层发育异常,其特征为严重少牙、甲发育异常、掌跖角化过度、皮肤干燥、毛发稀少以及手掌和足底多汗。WNT10A基因双等位基因突变导致的外胚层发育异常会产生高度可变的表型,范围从孤立性牙齿缺失到OODD和舍普夫-舒尔茨-帕萨热综合征(SSPS)。 病例报告:我们鉴定出一名女性患者,其父母为近亲结婚,临床诊断为OODD。基因检测显示,她对于WNT10A基因中一个先前报道的致病突变c.321C>A、p.Cys107*呈纯合状态。皮肤和指甲异常多年来一直被诊断为银屑病并据此进行治疗。全面的临床检查发现毛发稀少和足底多汗,牙科检查发现除两颗上颌中切牙外恒牙均缺失。取自角化过度的手掌和足底的皮肤活检显示了小汗腺导管纤维腺瘤病的特征性变化,这种变化已在患有外胚层发育异常的患者中有所描述。结合牙齿异常的家族史,这导致临床怀疑为遗传性外胚层发育异常。 结论:本病例说明了诊断像OODD这样的外胚层发育异常所面临的挑战,并强调了跨学科合作在罕见病诊断中的相关性。
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