title: Differential diagnosis of muscular hypotonia in infants: the kyphoscoliotic type of Ehlers-Danlos syndrome (EDS VI).
abstract: The kyphoscoliotic type of Ehlers-Danlos syndrome (EDS VI) (OMIM 225400) is an inherited connective tissue disorder characterized by hypotonia and kyphoscoliosis at birth, joint hypermobility, and skin hyperelasticity and fragility. Biochemically, it is characterized by a deficiency of collagen lysyl hydroxylase (EC 1.14.11.4) due to mutations in PLOD1. This deficiency results in underhydroxylation of collagen lysyl residues and, hence, an abnormal pattern of lysyl pyridinoline (LP) and hydroxylysyl pyridinoline (HP) crosslinks excreted in the urine. Because of hypotonia and delay in gross motor development, a neuromuscular disease is usually suspected, and in most cases the diagnosis is considered only very late, after performing an invasive neuromuscular work-up with normal results. We report a 12-month-old boy with kyphoscoliosis and delayed gross motor development, in whom the differential diagnosis of kyphoscoliotic type of Ehlers-Danlos syndrome (EDS VI) was initially suspected and successively confirmed by the abnormal urinary ratio of total pyridinolines (LP to HP), and by mutation analysis. We advocate the analysis of urinary pyridinolines in all infants with severe hypotonia which is highly specific and sensitive, quick and inexpensive.
authors.affiliation: Division of Child Neurology, Dokuz Eylül University School of Medicine, Department of Pediatrics, 35340 Izmir, Turkey. ulyis@yahoo.com
authors.forename: Uluç
authors.initials: U
authors.lastname: Yiş
authors.forename: Eray
authors.initials: E
authors.lastname: Dirik
authors.forename: Cèline
authors.initials: C
authors.lastname: Chambaz
authors.forename: Beat
authors.initials: B
authors.lastname: Steinmann
authors.forename: Cecilia
authors.initials: C
authors.lastname: Giunta
mesh_terms: D003937:Diagnosis, Differential; D004535:Ehlers-Danlos Syndrome / Q000175:diagnosis* / Q000235:genetics; D006801:Humans; D007223:Infant; D007738:Kyphosis / Q000000981:diagnostic imaging* / Q000235:genetics; D008297:Male; D009123:Muscle Hypotonia / Q000175:diagnosis* / Q000235:genetics; D020125:Mutation, Missense; D008240:Procollagen-Lysine, 2-Oxoglutarate 5-Dioxygenase / Q000235:genetics; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000235:genetics
chemical_list: D008240:Procollagen-Lysine, 2-Oxoglutarate 5-Dioxygenase