背景:多系统平滑肌功能障碍综合征(MSMDS)是一种影响多个器官的遗传疾病。这里的报告涉及一名MSMDS患者,到目前为止,他是所有报告的患者中最年轻的。除了典型的表现,我们观察到以前未报告的眼部异常,包括持续性血管前膜(TVL)和早发性视网膜小动脉迂曲,通过荧光素血管造影术(FA)。
方法:患者出生后立即进入新生儿重症监护病房,诊断胎儿时期泌尿系统发育不良。经过彻底检查,患者被发现动脉导管未闭,肺动脉高压,脑血管疾病,低张性膀胱,肠旋转不良,和先天性散瞳。在她的6周内进行的眼睛FA显示,在持续的前TVL和突出的视网膜小动脉弯曲中灌注了脉管系统。整个外显子组测序揭示了从头杂合ACTA2基因错义突变p.R179H。
方法:患者诊断为MSMDS。
方法:随访观察。
结果:在3个月的随访中,未观察到眼部疾病的变化。
结论:在这种情况下,持续的前TVL意味着ACTA2p.R179H突变不仅影响平滑肌细胞,还影响周细胞,并进一步影响TVL回归。在这个6周大的婴儿中,突出的视网膜小动脉弯曲表明视网膜小动脉弯曲可以在MSMDS早期出现。
BACKGROUND: Multisystemic smooth muscle dysfunction syndrome (MSMDS) is a genetic disease that affects multiple organs. The report here concerns a patient with MSMDS, who is known so far as the youngest among all the reported patients. In addition to the typical manifestations, we observed previously unreported ocular abnormalities, including persistent anterior tunica vasculosa lentis (TVL) and early-onset retinal arteriolar tortuosity, by the fluorescein angiography (FA).
METHODS: The patient was admitted to the neonatal intensive care unit immediately after birth for a diagnosis of urinary system dysplasia during fetal life. After a thorough examination, the patient was found with patent ductus arteriosus, pulmonary hypertension, cerebrovascular disease, hypotonic bladder, intestinal malrotation, and congenital mydriasis. The FA of the eyes undertaken in her 6-week demonstrated perfused vasculature in the persistent anterior TVL and prominent retinal arteriolar tortuosity. The whole exome sequencing revealed a de novo heterozygous ACTA2 gene missense mutation p.R179H.
METHODS: The patient was diagnosed with MSMDS.
METHODS: Follow-up observation.
RESULTS: At the 3-month follow-up, no change of the ocular disease was observed.
CONCLUSIONS: The persistent anterior TVL in this
case implies that ACTA2 p.R179H mutation affects not only the smooth muscle cells but also the pericytes, and further affects the TVL regression. The prominent retinal arteriolar tortuosity in this 6-week-old infant indicates that the retinal arteriolar tortuosity can present early in MSMDS.