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Case report
Novel NSDHL gene variant for congenital hemidysplasia with ichthyosiform erythroderma and limb defects (CHILD) syndrome
  1. Ebner Bon Gatus Maceda1,
  2. Lisa E Kratz2,
  3. Veronica Marie E Ramos3 and
  4. Mary Ann R Abacan1,4
  1. 1Division of Clinical Genetics, Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  2. 2Biochemical Genetics Laboratory, Kennedy Krieger Institute, Baltimore, Maryland, USA
  3. 3Dermatology, University of the Philippines Manila, Manila, Philippines
  4. 4Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
  1. Correspondence to Dr Ebner Bon Gatus Maceda; egmaceda{at}up.edu.ph

Abstract

We report a case of a 1-year and 2-month-old girl with clinical features consistent with congenital hemidysplasia with ichthyosis and limb defects syndrome. Sterol analysis from skin flakes revealed increased levels of a mono 4-alpha methyl sterol also seen in plasma as well as the presence of 4-alpha-carboxy-4-methyl-cholest-8(9)-en-3beta-ol and several keto-sterols, which are usually below the limit of detection. This sterol pattern is consistent with abnormal function of the 4-alpha-methylsterol-4-demethylase complex. NSDHL gene testing revealed the presence of a variant of uncertain significance, c.130G>A (p.Gly44Ser). This missense mutation currently is not included in population databases (ExAC no frequency) and has not been reported in individuals with an NSDHL-related condition. Parental studies showed that neither parent carries the NSDHL variant. On this basis, this variant has been reclassified as likely pathogenic. Symptomatic treatment with keratolytic agents, emollients and ketoconazole was initiated.

  • genetics
  • dermatology

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Footnotes

  • Contributors Each of the authors contributed in writing the manuscript. EBGM is the primary author and has initiated the planning and writing of the paper. LEK participated in the planning, analysis of the sterol analysis and writing of the manuscript specifically in this area. VMER participated in the planning, clinical examination of the dermatologic findings and the writing of the manuscript in this area. MARA participated in the planning, analysis and writing of the manuscript. She is the adviser of main adviser in writing the manuscript as well.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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