Coffin–Siris syndrome (CSS) is one of the several causes of intellectual disability (ID) and, since its first description, has posed diagnostic challenges given its variability and phenotypic overlap with other alterations of chromatin-remodeling-associated syndromes. It is genetically heterogeneous, and causative mutations are detected in less than 70% of cases. The different subtypes of the syndrome described to date are caused by mutations in genes that encode subunits of the SWI/SNF chromatin-remodeling complex, which plays an essential role in the regulation of gene expression during embryogenesis. Whole exome sequencing (WES) has allowed the identification of pathogenic mutations in these genes, including ARID2. ARID2 is one of the primary components of the SWI/SNF complex and has been associated with ID and phenotypes similar to CSS for the first time in 2015. Fifteen published case reports have identified loss-of-function mutations, suggesting that the underlying pathogenic disease mechanism is haploinsufficiency of ARID2.We herein presented the case of an 8-year-old Chilean girl with clinical suspicion of CSS, in whom a novel frameshift variant in ARID2 was identified by WES. She was the first reported case in Latin America to our knowledge and her phenotype displays the main clinical features suggestive of CSS described in other patients with ARID2 variants. However, she did not present behavioral abnormalities, a characteristic frequently reported in the majority of patients with ARID2 variants, and also had some features, such as sparse scalp hair, which is frequently reported as a manifestation of CSS, but is uncommon in this new group of patients.
El Síndrome de Tatton Brown Rahman (STBR) es un síndrome de sobrecrecimiento recientemente reportado, producido por variantes en el gen DNMT3A. La descripción de su fenotipo y diferencias con sus principales diagnósticos diferenciales se encuentran aún en desarrollo, con pocos sujetos de origen latinoamericano identificados. Objetivo: Describir un caso de STBR en un individuo de población chilena para ampliar el espectro fenotípico y genotípico de este nuevo síndrome. Caso Clínico: Escolar de 9 años diagnosticado con STBR a través de secuenciación completa de exoma (WES) en quién se identificó la variante DNMT3A: c.2311C > T, p. (Arg771*) no reportada previamente en la literatura en individuos con la condición. Presentaba las principales características de este síndrome con sobrecrecimiento desde la etapa neonatal, discapacidad intelectual leve asociada a trastorno del espectro autista, ausencia de anomalías mayores en órganos internos y dismorfias características con facies tosca, cejas horizontalizadas e incisivos centrales superiores prominentes. Tuvo un electroencefalograma alterado con frecuente actividad epileptiforme interictal temporal izquierda, sin historia de convulsiones, y resonancia magnética de cerebro normal. Además, presentaba una edad ósea avanzada, hallazgo común en otros síndromes de sobrecrecimiento pero no reportado con frecuencia en el STBR. El estudio genético de su hermana resultó normal y no se pudo realizar el estudio de segregación de la variante identificada en los padres. Conclusiones: El reporte de este caso contribuye a ampliar el espectro genotípico del síndrome y a la caracterización de las manifestaciones fenotípicas incluyendo individuos de distintas etnias, recalcando sus características más comunes y otras que dificultan su diagnóstico diferencial de otros síndromes de sobrecrecimiento.
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