Hereditary Haemorrhagic Telangiectasia (HHT) Marked by ACVRL1C1120T Variant Displays Hypopigmented Naevi and Frequent Bleeding Episodes if CYP2C9 Co-Mutated: Clinical Notes & Rationale of Patient Registry
Language English Country Czech Republic Media print
Document type Case Reports, Journal Article
PubMed
32512653
DOI
10.14712/fb2020066010001
PII: file/5915/fb2020a0001.pdf
Knihovny.cz E-resources
- MeSH
- Cytochrome P-450 CYP2C9 genetics MeSH
- Epistaxis MeSH
- Telangiectasia, Hereditary Hemorrhagic genetics MeSH
- Humans MeSH
- Skin Neoplasms genetics MeSH
- Registries MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- Names of Substances
- CYP2C9 protein, human MeSH Browser
- Cytochrome P-450 CYP2C9 MeSH
Hereditary haemorrhagic telangiectasia (HHT) exhibits considerable phenotypic heterogeneity. Therefore, precise mutation screening and evaluation of patient risk must be determined in every HHT family. We present an HHT-2 case with an initial life-threatening bleeding episode that led to identification of a relatively large HHT family. Exome sequencing of the family members determined HHT-associated ACVRL1C1120T variant resulting in Arg374Trp substitution at the Ser/Thr-kinase domain region. The affected members display typical epistaxis symptomatology from early childhood resulting in sideropoenia. In addition, the HHT patients also displayed dermatology findings such as facial teleangiectasias and trunk/limb white spots representing post-inflammatory hypopigmentation. Interestingly, co-segregating with modifying cytochrome P450 (CYP2C) variant in the HHT patients led to NSAID intolerance marked by increased frequency of bleeding episodes. No arterial-venous malformation of the visceral organs and brain or association with cancer were observed. The heterogeneity of clinical presentation and the role of other variants support the need of regular patient monitoring and development of a nation-wide patient registry.
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