Accidental finding of a cri du chat syndrome in an adult patient by means of array-CGH
*Correspondencia: Dra. Concepción Alonso Cerezo. Genética Clínica. Servicio de Análisis Clínicos. Instituto de Investigación Sanitaria. Hospital Universitario de La Princesa. Diego de León, 62. E-28006 Madrid.
E-mail: calonsoc.hlpr@salud.madrid.org
Introduction: The cri du chat syndrome (CDCS) come from a partial or total deletion of the short arm of chromosome 5, being one of the most common deletion syndromes in human beings. The great majority of patients are diagnosed between the first month and first year of life, but herein we report a finding of a CDCS in a woman with a suspect of spinocerebellar ataxia, and a family medical record of ataxia and bipolar disorder. We pay special attention to the clinical features as well as the diagnostics tests, used to identify the CDCS.
Case report: We report a case of a 46 years-old woman showing a borderline intelligence and bilateral cataract surgery at the age of 43. Beginning of symptoms in childhood included hypoacusia, ataxia, dysarthria, dysphagia, depression, cognitive impairment and bipolar disorder. Physical examination showed microcephaly, micrognathia, talipes equinovarus and ataxia. Karyotype and array-CGH were carried out on peripheral blood. The patient showed a rearrangement involving chromosomes 5 and 15, as well as an inversion of chromosome 9: 45,XX,inv9(p11q13);t(5,15)(p15.33;q11.2). Array comparative genomic hybridization was performed showing a 2.91 Mb deletion at 5p15.33, genomic formula arr 5p15.33 (151537-3057771)x1. The deletion involved 20 genes, including TERT gene.
Conclusions: The multiple gene deletions confirmed the CDCS diagnosis, being responsible for the patient phenotype. It has been showed up the importance of using the correct diagnosis techniques (array-CGH, peripheral blood karyotype) as well as their appropriate choice.
Caso clínico Mujer de 46 años que presentaba una inteligencia límite, intervenida a los 43 años de faquectomía bilateral. El inicio de la sintomatología fue durante la infancia, e incluía hipoacusia, ataxia, disartria, disfagia, depresión, deterioro cognitivo y trastorno bipolar. La exploración física reveló microcefalia, micrognatia, pies equinos y ataxia. Se realizó cariotipo y array-CGH en sangre periférica. La paciente presentaba una traslocación que involucraba los cromosomas 5 y 15, y una inversión del cromosoma 9: 45,XX,inv9(p11q13);t(5,15)(p15.33;q11.2). El array-CGH mostró una deleción de 2,91 Mb en 5p15.33, fórmula genómica arr 5p15.33 (151537-3057771)x1, que involucraba 20 genes, incluyendo el gen TERT.
Conclusiones La deleción de múltiples genes confirmó el diagnóstico de SCDC y es la responsable del fenotipo de la paciente. Se pone de manifiesto la importancia de utilizar técnicas adecuadas de diagnóstico (array-CGH, cariotipo en sangre periférica) y la correcta elección de éstas.