Spurious case of XX maleness in a patient with a history of Wiskott-Aldrich syndrome.
OBJECTIVE
To alert endocrinologists about the potential for karyotype confusion in patients who have undergone bone marrow transplantation.


METHODS
Clinical, laboratory, and imaging data are reported on a young adult male patient who initially presented because of concerns about short stature.


RESULTS
An 18-year-old fully virilized male patient with a history of Wiskott-Aldrich syndrome had undergone successful bone marrow transplantation in infancy. The donor was his older sister. Many years later, he underwent evaluation because of short stature and was found to have a 46, XX karyotype. This unexpected finding led to several costly laboratory and imaging studies, as well as a new diagnosis of a disorder of sex development. The patient was referred to our medical center for further evaluation of XX sex reversal. A skin biopsy was eventually performed, which revealed a 46, XY karyotype. This unusual case highlights the fact that a peripheral blood specimen from bone marrow transplant recipients reflects the genetic makeup of the bone marrow donor.


CONCLUSIONS
Although the cytogenetic changes that occur in recipients of bone marrow transplants are well known to hematologists and oncologists, they are not commonly recognized by other health care providers. Increased awareness of this potential situation in long-term survivors of bone marrow transplantation is needed.
Department of Pediatrics, Section of Pediatric Endocrinology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA. tdnebesi@iupui.edu
Todd D
TD
Nebesio
Wilfredo
W
Torres-Martinez
Richard C
RC
Rink
Erica A
EA
Eugster
D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D006801:Humans; D007621:Karyotyping; D008297:Male; D050090:Ovotesticular Disorders of Sex Development / Q000175:diagnosis* / Q000209:etiology / Q000235:genetics*; D014923:Wiskott-Aldrich Syndrome / Q000628:therapy*