Xu Rongrong, Zhou Hua, Fang Feng, Qiu Liru, Liu Xinglou
Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Transl Pediatr. 2022 Apr;11(4):595-600. doi: 10.21037/tp-21-535.
Alstrom syndrome (ALMS) is an ultra-rare multisystem genetic disorder caused by autosomal recessive inheritance of the ALMS1 gene. It manifests as multisystem dysfunction, displaying unique clinical signs and symptoms and various severity, which may lead to delayed prognosis or misdiagnosis in medical practice. Although almost 300 pathogenic variants have been reported, there are some variant sites that have not been recognized yet.
We report a case of a 14-year-old boy with manifestations, including binocular vision loss, acanthosis nigricans, type 2 diabetes, insulin resistance, elevated transaminase, hepatic fibrosis, and proteinuria. Compound heterozygous variants in the gene have been discovered by whole exon sequencing. One of his variant sites was C. 8158C>T, which was from his father. And the other variant site was C. 3575C>A, which was from his mother. To the great of our knowledge, this site has not been reported before. Both of the variants make the synthesis of the peptide chain terminated in advance and an incomplete polypeptide chain is formed.
The clinical presentations of ALMS are complicated and varied. Although early diagnosis can be made according to typical clinical symptoms, whole exon sequencing is necessary for the diagnosis of ALMS, as indicated by our study.
阿尔斯特伦综合征(ALMS)是一种极为罕见的多系统遗传性疾病,由ALMS1基因的常染色体隐性遗传引起。它表现为多系统功能障碍,呈现出独特的临床体征和症状,且严重程度各异,这可能导致在医疗实践中预后延迟或误诊。尽管已报道了近300种致病变异,但仍有一些变异位点未被识别。
我们报告一例14岁男孩的病例,其表现包括双眼视力丧失、黑棘皮病、2型糖尿病、胰岛素抵抗、转氨酶升高、肝纤维化和蛋白尿。通过全外显子测序发现该基因存在复合杂合变异。其中一个变异位点为C.8158C>T,来自其父亲。另一个变异位点为C.3575C>A,来自其母亲。据我们所知,该位点此前尚未见报道。这两个变异均使肽链合成提前终止,形成不完整的多肽链。
ALMS的临床表现复杂多样。尽管根据典型临床症状可进行早期诊断,但如我们的研究所示,全外显子测序对于ALMS的诊断是必要的。