title: antiphospholipid antibodies syndrome associated with hyperhomocysteinemia related to MTHFR Gene C677T and A1298C heterozygous mutations in a young man with idiopathic hypoparathyroidism (DiGeorge syndrome).
abstract: BACKGROUND
  Antiphospholipid syndrome (APS, or Hughes' syndrome) is a systemic autoimmune disorder characterized by antiphospholipid antibody positivity, which may lead to arterial and/or venous thrombosis. Hyperhomocysteinemia (HHcy), variously associated with 5,10-methylene tetrahydrofolate reductase (MTHFR) gene point mutations, is also implicated in thromboembolic events. The association of APS and HHcy has already been described but has never been reported in patients with DiGeorge syndrome (DGS), the most common contiguous-gene deletion syndrome (22q11.2) in humans, whose phenotype conversely includes bleeding disorders.
  
  
  METHODS
  In this report, we present the case of a 19-yr-old patient with a past medical history of learning disability and obesity affected with idiopathic hypoparathyroidism, metabolic syndrome, and diffuse vasculitis disorders. He was referred to our endocrinology clinic for the management of severe hypocalcemia. At the time of presentation he had been taking antiepileptic drugs for 2 wk and displayed facial dysmorphism (short neck, micrognathia, a small mouth, hypoplastic nasal alae, eye hypertelorism, and low-set simple ears). DGS was suspected and confirmed by both fluorescence in situ hybridization analysis and single nucleotide polymorphism-array analysis, which revealed contiguous gene microdeletion of the chromosome 22q11.2 in the minimal DiGeorge critical region, specifically at the gene locus D22S75 (N25).
  
  
  CONCLUSIONS
  APS, revealed by anti-beta-2-glycoprotein and anti-prothrombin antibodies positivity, and moderate HHcy related to heterozygous C677T and A1298C point mutations of the MTHFR gene were identified as a possible cause of thrombotic disorder responsible for the widespread presence of cutaneous and cerebral lesions.
authors.affiliation: Sezione di Endocrinologia quarto (IV) Piano Pad. H., Dipartimento Clinico-Sperimentale di Medicina e Farmacologia, University of Messina., A.O.U. Policlinico "G. Martino", Via Consolare Valeria 1, 98100 Messina, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Nucera
authors.forename: Mario
authors.initials: M
authors.lastname: Vaccaro
authors.forename: Mariacarla
authors.initials: M
authors.lastname: Moleti
authors.forename: Carmen
authors.initials: C
authors.lastname: Priolo
authors.forename: Gaetano
authors.initials: G
authors.lastname: Tortorella
authors.forename: Adriano
authors.initials: A
authors.lastname: Angioni
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ientile
authors.forename: Maria Antonia
authors.initials: MA
authors.lastname: Violi
authors.forename: Massimo
authors.initials: M
authors.lastname: Loda
authors.forename: Francesco
authors.initials: F
authors.lastname: Trimarchi
authors.forename: Francesco
authors.initials: F
authors.lastname: Vermiglio
mesh_terms: D000328:Adult; D016736:Antiphospholipid Syndrome / Q000209:etiology*; D004062:DiGeorge Syndrome / Q000235:genetics* / Q000276:immunology / Q000473:pathology; D006801:Humans; D020138:Hyperhomocysteinemia / Q000209:etiology*; D007011:Hypoparathyroidism / Q000235:genetics*; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics*; D009154:Mutation
chemical_list: D042965:Methylenetetrahydrofolate Reductase (NADPH2)