title: Severe facial clefts in acrofacial dysostosis: a consequence of prenatal exposure to mycophenolate mofetil?
abstract: BACKGROUND
  Immunosuppressants are teratogenic in mice, rats, and rabbits and cause prenatal growth restriction in humans. As yet, there has been no proven teratogenicity in humans.
  
  
  METHODS
  We present a chromosomally normal fetus with severe acrofacial dysostosis and orofacial clefts. These were bilateral transverse and oblique clefts and defects of the midface. In addition, there were preaxial limb anomalies with digitalization of thumbs and internal cardiovascular, gastrointestinal, and urogenital malformations. The mother had been treated with high doses of the immunosuppressant mycophenolate mofetil in early pregnancy for systemic lupus erythematosus.
  
  
  CONCLUSIONS
  Mycophenolate mofetil may have contributed to or even caused acrofacial dysostosis phenotype and extensive clefting.
authors.affiliation: Institute of Pathology, Philipps-University Marburg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Schoner
authors.forename: Johannes
authors.initials: J
authors.lastname: Steinhard
authors.forename: Jens
authors.initials: J
authors.lastname: Figiel
authors.forename: Helga
authors.initials: H
authors.lastname: Rehder
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000209:etiology / Q000473:pathology*; D000293:Adolescent; D019465:Craniofacial Abnormalities / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D005315:Fetal Diseases / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced* / Q000473:pathology
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid