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Antiphospholipid Antibodies Syndrome Associated with Hyperhomocysteinemia Related to MTHFR Gene C677T and A1298C Heterozygous Mutations in a Young Man with Idiopathic Hypoparathyroidism (DiGeorge Syndrome)

Sezione di Endocrinologia (C.N., M.M., M.A.V., F.T., F.V.), Dipartimento Clinico-Sperimentale di Medicina e Farmacologia, Sezione di Dermatologia-Dipartimento di Medicina Sociale e del Territorio (M.V.), Sezione di Neuropsichiatria Infantile (G.T.), Dipartimento di Scienze Pediatriche Mediche e Chirurgiche, and Sezione di Biochimica e Biochimica Clinica (R.I.), Dipartimento di Biochimica, Fisiologia e Scienze della Nutrizione, University of Messina, 98100 Messina, Italy; Dana-Farber Cancer Institute (C.P., M.L.), Harvard Medical School, Boston, Massachusetts, 02115; Regina Elena Cancer Institute (C.P.), Medical Oncology, 00144 Roma, Italy; and Laboratorio di Citogenetica e Genetica Molecolare (A.A.), Ospedale Pediatrico Bambino Gesù, Istituto Di Ricovero e Cura a Carattere Scientifico, 00165 Roma, Italy

Address all correspondence and requests for reprints to: Francesco Vermiglio, M.D., Sezione di Endocrinologia quarto (IV) Piano Pad. H., Dipartimento Clinico-Sperimentale di Medicina e Farmacologia, University of Messina., A.O.U. Policlinico "G. Martino", Via Consolare Valeria 1, 98100 Messina, Italy. E-mail: francesco.vermiglio{at}unime.it.

Context: Antiphospholipid syndrome (APS, or Hughes’ syndrome) is a systemic autoimmune disorder characterized by antiphospholipid antibody positivity, which may lead to arterial and/or venous thrombosis. Hyperhomocysteinemia (HHcy), variously associated with 5,10-methylene tetrahydrofolate reductase (MTHFR) gene point mutations, is also implicated in thromboembolic events. The association of APS and HHcy has already been described but has never been reported in patients with DiGeorge syndrome (DGS), the most common contiguous-gene deletion syndrome (22q11.2) in humans, whose phenotype conversely includes bleeding disorders.

Data Acquisition: In this report, we present the case of a 19-yr-old patient with a past medical history of learning disability and obesity affected with idiopathic hypoparathyroidism, metabolic syndrome, and diffuse vasculitis disorders. He was referred to our endocrinology clinic for the management of severe hypocalcemia. At the time of presentation he had been taking antiepileptic drugs for 2 wk and displayed facial dysmorphism (short neck, micrognathia, a small mouth, hypoplastic nasal alae, eye hypertelorism, and low-set simple ears). DGS was suspected and confirmed by both fluorescence in situ hybridization analysis and single nucleotide polymorphism-array analysis, which revealed contiguous gene microdeletion of the chromosome 22q11.2 in the minimal DiGeorge critical region, specifically at the gene locus D22S75 (N25).

Conclusions: APS, revealed by anti-ß-2-glycoprotein and anti-prothrombin antibodies positivity, and moderate HHcy related to heterozygous C677T and A1298C point mutations of the MTHFR gene were identified as a possible cause of thrombotic disorder responsible for the widespread presence of cutaneous and cerebral lesions.

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