antiphospholipid antibodies syndrome associated with hyperhomocysteinemia related to MTHFR Gene C677T and A1298C heterozygous mutations in a young man with idiopathic hypoparathyroidism (DiGeorge syndrome).
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.
Nucera
Carmelo
C
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.
Vaccaro
Mario
M
Moleti
Mariacarla
M
Priolo
Carmen
C
Tortorella
Gaetano
G
Angioni
Adriano
A
Ientile
Riccardo
R
Violi
Maria Antonia
MA
Loda
Massimo
M
Trimarchi
Francesco
F
Vermiglio
Francesco
F
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
D042965:Methylenetetrahydrofolate Reductase (NADPH2)