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A limited form of proteus syndrome with bilateral plantar cerebriform collagenomas and varicose veins secondary to a mosaic AKT1 mutation.
[proteus syndrome]
Proteus
syndrome
is
an
extremely
rare
disorder
of
mosaic
postnatal
overgrowth
affecting
multiple
tissues
including
bone
,
soft
tissue
,
and
skin
.
It
typically
manifests
in
early
childhood
with
asymmetric
and
progressive
skeletal
overgrowth
that
leads
to
severe
distortion
of
the
skeleton
and
disability
.
The
genetic
basis
has
recently
been
identified
as
a
somatic
activating
mutation
in
the
AKT
1
gene
,
which
encodes
an
enzyme
mediating
cell
proliferation
and
apoptosis
.
We
present
a
33
-
year
-old
man
who
developed
plantar
cerebriform
collagenomas
on
the
soles
of
both
feet
and
varicose
veins
in
early
childhood
,
in
the
absence
of
any
skeletal
or
other
connective
tissue
abnormality
.
Although
the
patient
did
not
meet
the
diagnostic
criteria
for
Proteus
syndrome
,
he
was
found
to
have
the
c
.
49
G
>
A
,
p
.
Glu
17
Lys
AKT
1
mutation
in
lesional
skin
but
not
in
his
blood
.
To
our
knowledge
,
this
is
the
mildest
molecularly
confirmed
case
of
Proteus
syndrome
,
occurring
in
the
absence
of
the
characteristic
skeletal
overgrowth
.
These
findings
extend
the
spectrum
of
Proteus
syndrome
pathological
characteristics
and
suggest
that
somatic
mutations
late
in
development
and
restricted
in
distribution
cause
subtle
clinical
presentations
that
do
not
meet
the
published
clinical
criteria
.
Diseases
Validation
Diseases presenting
"progressive skeletal overgrowth"
symptom
proteus syndrome
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