Jun 03, 2019

The participant was born with multiple heart abnormalities (coarctation of the aorta, bicuspid aortic valve, ventricular septal defect) and was diagnosed with Wolff-Parkinson-White syndrome at 5 months old. Also at 5 months old, he was diagnosed with acute lymphoblastic leukemia (ALL) and was treated with chemotherapy, total body irradiation, and a bone marrow transplant at 18 months.

At age 7, the participant was found to have multiple abnormal bone and cartilage growths (osteochondromas). He had surgery when he was 13 years old to remove an osteochondroma from his spine, which had been causing temporary paralysis in his legs.

The participant is also very sensitive to the sun and will burn very quickly whenever he is outside.

Since early childhood, the participant has had global developmental delay and currently has moderate intellectual disability and autism spectrum disorder. He has an Individualized Education Program (IEP) at school.

The patient’s history and laboratory findings have led to suspicion that he has a yet unidentified chromosome breakage disorder.

• Intellectual disability
• Anxiety
• Autistic behavior
• Repetitive behaviors (stereotypy)
• Fear of loud sounds (phonophobia)
• Muscle tone abnormalities (generalized hypotonia, upper limb hypertonia, lower limb hypertonia)
• Uncoordinated walking (gait ataxia)
• Overactive reflexes (hyperreflexia in upper limbs, ankle clonus)
• Abnormalities of eye movement (frequent saccadic intrusions on smooth pursuit)
• Heart abnormalities (coarctation of the aorta, bicuspid aortic valve, muscular ventricular septal defect, Wolff-Parkinson-White syndrome)
• Acute lymphoblastic leukemia (ALL)
• Lower limb asymmetry
• Short stature
• Large hands
• Long fingers
• Prominent fingertip pads
• Toe abnormalities (overlapping toe, 2-3 toe cutaneous syndactyly, splayed toes)
• Abnormal facial features (full cheeks, oval face, sparse and thin eyebrow, medial flaring of the eyebrow, deeply set eyes, downslanted palpebral fissures, wide nasal bridge, bulbous nose, low-set ears, large earlobe, asymmetry of the size of ears, broad philtrum, short philtrum, downturned corners of mouth, narrow mouth, thin upper vermilion, mandibular prognathia, facial asymmetry)
• Bony growth on the roof of mouth (torus palatinus)
• Widely spaced teeth
• Small teeth (microdontia)
• Benign fat tumors (lipoma)
• Benign bone tumors (osteochondromas)
• Skin abnormalities (hyperkeratosis, cutaneous photosensitivity, skin tags, numerous nevi, atypical scarring of skin)
• Nail abnormalities (small nails, deep-set nails)
• Liver abnormalities (liver lesions, hepatic steatosis)
• Kidney abnormalities (duplicated collecting system, multiple renal cysts)
• Early puberty (precocious puberty)
• Enlarged breasts (gynecomastia)
• Low levels of thyroid hormone (hypothyroidism)
• Insulin resistance
• High levels of triglycerides in blood (hypertriglyceridemia)
• Decreased HDL cholesterol concentration
• Excess calcium in the urine (hypercalciuria)

• Growth hormone – osteopenia
• Chemotherapy and total body irradiation – leukemia