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Lethal junctional epidermolysis bullosa with pyloric atresia due to compound heterozygosity for two novel mutations in the integrin β4 gene.
[junctional epidermolysis bullosa]
Junctional
epidermolysis
bullosa
with
pyloric
atresia
(
JEB-
PA
)
is
a
rare
autosomal
recessive
disease
with
blister
formation
within
the
lamina
lucida
due
to
mutations
in
the
integrin
β
4
(
ITGB
4
)
and
α
6
(
ITGA
6
)
genes
.
A
female
preterm
infant
,
first
child
of
healthy
non-consanguineous
parents
,
was
born
at
26
+
4
weeks
of
gestation
by
caesarean
section
,
following
polyhydramnion
and
abruption
of
placenta
.
She
presented
with
extensive
areas
of
denuded
skin
on
both
lateral
sides
of
the
head
,
neck
and
extremities
.
Auricles
were
hypoplastic
.
Abdominal
ultrasound
and
X-
ray
were
suggestive
of
pyloric
atresia
which
was
revised
surgically
on
the
4
th
day
of
life
.
Further
course
was
complicated
by
progressive
skin
detachment
,
sepsis
,
and
renal
insufficiency
with
fatal
outcome
at
18
days
of
age
.
Immunofluorescence
mapping
of
cryopreserved
skin
showed
junctional
cleft
formation
with
negative
staining
for
integrin
α
6
and
integrin
β
4
.
Mutational
analysis
disclosed
compound
heterozygosity
for
two
novel
nonsense
mutations
in
the
ITGB
4
gene
:
c
.
600
dupC
/
p
.
F
2
01
fsX
14
and
c
.
2533
C
>
T
/
p
.
Q
845
X
.
2
subsequent
pregnancies
were
terminated
following
prenatal
diagnosis
disclosing
the
same
ITGB
4
mutations
,
a
4
th
pregnancy
was
unaffected
.
We
describe
a
case
of
lethal
JEB-
PA
with
negative
immunoreactivity
to
integrin
α
6
and
integrin
β
4
predicting
a
poor
outcome
.
Identification
of
compound
heterozygosity
for
two
novel
ITGB
4
mutations
in
the
affected
preterm
infant
permitted
prenatal
diagnosis
and
finally
birth
of
a
healthy
sibling
.
Diseases
Validation
Diseases presenting
"prenatal diagnosis"
symptom
22q11.2 deletion syndrome
achondroplasia
adrenomyeloneuropathy
alexander disease
alpha-thalassemia
aromatase deficiency
benign recurrent intrahepatic cholestasis
cadasil
canavan disease
classical phenylketonuria
cohen syndrome
congenital adrenal hyperplasia
congenital diaphragmatic hernia
congenital toxoplasmosis
cystinuria
dentinogenesis imperfecta
epidermolysis bullosa simplex
harlequin ichthyosis
holt-oram syndrome
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
junctional epidermolysis bullosa
kindler syndrome
krabbe disease
lamellar ichthyosis
megacystis-microcolon-intestinal hypoperistalsis syndrome
monosomy 21
neonatal adrenoleukodystrophy
oculocutaneous albinism
omenn syndrome
phenylketonuria
primary hyperoxaluria type 1
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severe combined immunodeficiency
wolf-hirschhorn syndrome
x-linked adrenoleukodystrophy
zellweger syndrome
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