title: Vascular Ehlers-Danlos syndrome without the characteristic facial features: a case report.
abstract: As a type of Ehlers-Danlos syndrome (EDS), vascular EDs (vEDS) is typified by a number of characteristic facial features (eg, large eyes, small chin, sunken cheeks, thin nose and lips, lobeless ears). However, vEDs does not typically display hypermobility of the large joints and skin hyperextensibility, which are features typical of the more common forms of EDS. Thus, colonic perforation or aneurysm rupture may be the first presentation of the disease. Because both complications are associated with a reduced life expectancy for individuals with this condition, an awareness of the clinical features of vEDS is important. Here, we describe the treatment of vEDS lacking the characteristic facial attributes in a 24-year-old healthy man who presented to the emergency room with abdominal pain. Enhanced computed tomography revealed diverticula and perforation in the sigmoid colon. The lesion of the sigmoid colon perforation was removed, and Hartmann procedure was performed. During the surgery, the control of bleeding was required because of vascular fragility. Subsequent molecular and genetic analysis was performed based on the suspected diagnosis of vEDS. These analyses revealed reduced type III collagen synthesis in cultured skin fibroblasts and identified a previously undocumented mutation in the gene for a1 type III collagen, confirming the diagnosis of vEDS. After eliciting a detailed medical profile, we learned his mother had a history of extensive bruising since childhood and idiopathic hematothorax. Both were prescribed oral celiprolol. One year after admission, the patient was free of recurrent perforation. This case illustrates an awareness of the clinical characteristics of vEDS and the family history is important because of the high mortality from this condition even in young people. Importantly, genetic assays could help in determining the surgical procedure and offer benefits to relatives since this condition is inherited in an autosomal dominant manner.
authors.affiliation: From the Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan (RI, HK, YK, SN, NY); Department of Emergency Medicine, JR General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo 151-8528, Japan (RI, KE); Department of Surgery, Hanna Central Hospital, 741 Tawaraguchi, Ikoma city, Nara 630-0243, Japan (HK); and Department of Dermatology, Dokkyo Medical University, School of Medicine, Kitakobayashi, Mibu, Tochigi 321-0293, Japan (AH).
authors.forename: Ryota
authors.initials: R
authors.lastname: Inokuchi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kurata
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Endo
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Kitsuta
authors.forename: Susumu
authors.initials: S
authors.lastname: Nakajima
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hatamochi
authors.forename: Naoki
authors.initials: N
authors.lastname: Yahagi
mesh_terms: D024061:Collagen Type III / Q000235:genetics; D012809:Colon, Sigmoid; D003937:Diagnosis, Differential; D013505:Digestive System Surgical Procedures / Q000379:methods; D004535:Ehlers-Danlos Syndrome / Q000150:complications / Q000175:diagnosis / Q000235:genetics*; D005145:Face / Q000033:anatomy & histology*; D005820:Genetic Testing; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008297:Male; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D024061:Collagen Type III