The HLA-linked human steroid 21-hydroxylase gene CYP21B and its closely homologous pseudogene CYP2JA are each normally located centromeric to a fourth component of complement (C4) (1). Although clinically heterogeneous, the disorder is always characterized by accumulation of 17-hydroxyprogesterone and by excessive androgen production, which, in the classical form of the disorder, results in masculinization ofthe external genitalia in affected female newborns.In addition, -70% ofclassical 21-OH deficiency patients show an inability to conserve dietary sodium ("salt-wasting") as a consequence of parallel deficiency in aldosterone production. The disorder maps within the class III region of the HLA complex on the short arm of chromosome 6, and molecular genetic investigations have revealed that most normal haplotypes contain, in addition to a functional 21-OH gene, CYP21B, a pseudogene, CYP21A, which shows 97% sequence homology to the functional gene. The CYP21A and CYP21B loci are positioned -=2 kilobases (kb) centromeric to the duplicated fourth component of complement (C4) genes, C4A and C4B, respectively (see Fig. 1), and the extant organization of these genes is presumed to reflect tandem duplication of an ancestral compound DNA unit -30 kb long and containing a single 21-OH gene and a single C4 gene (2, 3). Because of C4 gene length heterogeneity (4), the repeat units may be short (ca. 26 kb in length) or long (ca. 33 kb).The tandemly repeated organization of the 21-OH and C4 genes has been considered to facilitate gene deletion and addition events by unequal crossover mechanisms. Although the existence of haplotypes with variable numbers of C4 and 21-OH genes has been inferred by indirect short-range restriction mapping and complement C4 allotyping analyses, confirmation of the copy number variation has only recently been obtained by direct long-range restriction mapping approaches (5-7). Such studies have shown that gene expansion and contractions are frequent in the 21-OH/C4 gene cluster. Also, the size variation of haplotype-specific long-range restriction fragments that span the array of 21-OH and C4 genes is always consistent with integral numbers of the ca. 30-kb repeat units. Consequently, a considerable amount of circumstantial evidence has been accumulated in favor of the involvement of unequal crossover in the 21-OH/C4 gene cluster. In the present report, we present direct evidence for the occurrence of unequal crossover in this chromosomal region: a 21-OH deficiency patient has inherited a maternal haplotype that, as a result of meiotic recombination, has a ca. 30-kb de novo deletion that eliminates the functional CYP21B gene and a companion C4B gene.