Subdural hemorrhage, macrocephaly, rash, and developmental delay in an infant: A pathogenic variant in NLRP3 causes CINCA/NOMID.

Subdural hemorrhage, macrocephaly, rash, and developmental delay in an infant: A pathogenic variant in NLRP3 causes CINCA/NOMID.
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婴儿硬膜下出血、大头畸形、皮疹和发育迟缓:NLRP3 的致病性变异导致 CI​​NCA/NOMID。

DOI:
10.1002/ajmg.a.63366
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发表时间:
2023
期刊:
American journal of medical genetics. Part A
影响因子:
--
通讯作者:
Feldman,KennethW
Feldman,KennethW
中科院分区:
--
文献类型:
--
作者:
Koti,AjayS;Lanis,Aviya;Finlayson,Samuel;Canny,Susan;Feldman,ElanaA;Miller,DannyE;Rosenwasser,Natalie;Scott,AbbeyA;Wong,StephenC;Feldman,KennethW

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儿童硬膜下血肿(SDH)最常在虐待性头部创伤(AHT)中观察到,这是一种独特的创伤性脑损伤形式,但它们也可能发生在其他情况下,通常具有明确的体征和症状的替代诊断。我们提出了一个婴儿的情况下,其SDH最初提出了AHT的问题,但多学科的评估确定了多种异常,包括皮疹,大头畸形,生长障碍,炎症标志物升高,这都是非典型的创伤。这些,沿着明显的脑萎缩,脑室扩大,以及没有其他损伤,引起了对遗传疾病的关注,促使遗传咨询。临床三外显子组测序鉴定了NLRP 3中一种可能的新生致病性变体,该变体与慢性婴儿神经、皮肤和关节(CINCA)综合征(也称为新生儿发作性多系统炎性疾病(NOMID))相关。他成功地接受了白细胞介素-1阻断治疗,强调了CINCA/NOMID患者及时治疗的重要性。这个病例也说明了如何通过多学科合作和仔细考虑临床病史和检查结果,可以很容易地将SDH的非创伤性病例与AHT区分开来。
Subdural hemorrhages (SDHs) in children are most often observed in abusive head trauma (AHT), a distinct form of traumatic brain injury, but they may occur in other conditions as well, typically with clear signs and symptoms of an alternative diagnosis. We present a case of an infant whose SDH initially raised the question of AHT, but multidisciplinary evaluation identified multiple abnormalities, including rash, macrocephaly, growth failure, and elevated inflammatory markers, which were all atypical for trauma. These, along with significant cerebral atrophy, ventriculomegaly, and an absence of other injuries, raised concerns for a genetic disorder, prompting genetic consultation. Clinical trio exome sequencing identified a de novo likely pathogenic variant inNLRP3, which is associated with chronic infantile neurological, cutaneous, and articular (CINCA) syndrome, also known as neonatal‐onset multisystem inflammatory disease (NOMID). He was successfully treated with interleukin‐1 blockade, highlighting the importance of prompt treatment in CINCA/NOMID patients. This case also illustrates how atraumatic cases of SDH can be readily distinguished from AHT with multidisciplinary collaboration and careful consideration of the clinical history and exam findings.
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