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Pediatr Neurol. 2016 Mar;56:62-68.e1. doi: 10.1016/j.pediatrneurol.2015.12.005. Epub 2015 Dec 19.

Hoyeraal-Hreidarsson Syndrome due to PARN Mutations: Fourteen Years of Follow-Up.

Author information

1
San Antonio Military Medical Center, San Antonio, Texas.
2
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.
3
Walter Reed National Military Medical Center, Bethesda, Maryland.
4
Children's National Medical Center, Washington, District of Columbia.
5
Cancer Genomics Research Laboratory, Leidos Biomedical Research, NCI-Frederick, Rockville, Maryland.
6
Division of Pediatric Oncology, Department of Oncology, Johns Hopkins University, Baltimore, Maryland.
7
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland. Electronic address: savagesh@mail.nih.gov.

Abstract

BACKGROUND:

Hoyeraal-Hreidarsson syndrome is a dyskeratosis congenita-related telomere biology disorder that presents in infancy with intrauterine growth retardation, immunodeficiency, and cerebellar hypoplasia in addition to the triad of nail dysplasia, skin pigmentation, and oral leukoplakia. Individuals with Hoyeraal-Hreidarsson syndrome often develop bone marrow failure in early childhood. Germline mutations in DKC1, TERT, TINF2, RTEL1, ACD, or PARN cause about 60% of individuals with Hoyeraal-Hreidarsson syndrome.

PATIENT DESCRIPTION:

We describe 14 years of follow-up of an individual with Hoyeraal-Hreidarsson syndrome who initially presented as an infant with intrauterine growth retardation, microcephaly, and central nervous system calcifications. He was diagnosed with Hoyeraal-Hreidarsson syndrome at age 6 years and had a complicated medical history including severe developmental delay, cerebellar hypoplasia, esophageal and urethral stenosis, hip avascular necrosis, immunodeficiency, and bone marrow failure evolving to myelodysplastic syndrome requiring hematopoietic cell transplantation at age 14 years. He had progressive skin pigmentation, oral leukoplakia, and nail dysplasia leading to anonychia. Whole exome sequencing identified novel biallelic variants in PARN.

CONCLUSIONS:

This patient illustrates that the constellation of intrauterine growth retardation, central nervous system calcifications, and cerebellar hypoplasia, esophageal or urethral stenosis, and cytopenias, in the absence of congenital infection, may be due to Hoyeraal-Hreidarsson syndrome. Early diagnosis of Hoyeraal-Hreidarsson syndrome is important to optimize medical management and provide genetic counseling.

KEYWORDS:

CNS calcification; Hoyeraal-Hreidarsson syndrome; PARN; dyskeratosis congenita; microcephaly; telomere

PMID:
26810774
PMCID:
PMC4789174
[Available on 2017-03-01]
DOI:
10.1016/j.pediatrneurol.2015.12.005
[Indexed for MEDLINE]
Free PMC Article

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