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Open Access 01-12-2020 | Systemic Sclerosis | Case Report

A case of Myhre syndrome mimicking juvenile scleroderma

Authors: Barbara Jensen, Rebecca James, Ying Hong, Ebun Omoyinmi, Clarissa Pilkington, Neil J. Sebire, Kevin J. Howell, Paul A. Brogan, Despina Eleftheriou

Published in: Pediatric Rheumatology | Issue 1/2020

Abstract

Background

Myhre syndrome is a genetic disorder caused by gain of function mutations in the SMAD Family Member 4 (SMAD4) gene, resulting in progressive, proliferative skin and organ fibrosis. Skin thickening and joint contractures are often the main presenting features of the disease and may be mistaken for juvenile scleroderma.

Case presentation

We report a case of a 13 year-old female presenting with widespread skin thickening and joint contractures from infancy. She was diagnosed with diffuse cutaneous systemic sclerosis, and treatment with corticosteroids and subcutaneous methotrexate recommended. There was however disease progression prompting genetic testing. This identified a rare heterozygous pathogenic variant c.1499 T > C (p.Ile500Thr) in the SMAD4 gene, suggesting a diagnosis of Myhre syndrome. Securing a molecular diagnosis in this case allowed the cessation of immunosuppression, thus reducing the burden of unnecessary and potentially harmful treatment, and allowing genetic counselling.

Conclusion

Myhre Syndrome is a rare genetic mimic of scleroderma that should be considered alongside several other monogenic diseases presenting with pathological fibrosis from early in life. We highlight this case to provide an overview of these genetic mimics of scleroderma, and highlight the molecular pathways that can lead to pathological fibrosis. This may provide clues to the pathogenesis of sporadic juvenile scleroderma, and could suggest novel therapeutic targets.

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Title: A case of Myhre syndrome mimicking juvenile scleroderma
Authors: Barbara Jensen
Rebecca James
Ying Hong
Ebun Omoyinmi
Clarissa Pilkington
Neil J. Sebire
Kevin J. Howell
Paul A. Brogan
Despina Eleftheriou
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Systemic Sclerosis
Juvenile Systemic Scleroderma
Scleroderma
Published in: Pediatric Rheumatology / Issue 1/2020
Electronic ISSN: 1546-0096
DOI: https://doi.org/10.1186/s12969-020-00466-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A case of Myhre syndrome mimicking juvenile scleroderma

Abstract

Background

Case presentation

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusion

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