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Participant 143


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Sharing information on this website is not a requirement of UDN participation. Only descriptions about participants who give explicit consent will appear here. While these participant pages are helpful to understand our participants’ stories, they do not begin to describe their diagnostic odysseys. A special thank you goes out to our participants and their families for sharing their experiences.

 

Female, age 5, with brain abnormalities, flow of urine from bladder to kidneys (vesicoureteral reflux), global developmental delay and atrial septal defect caused by a change in CHASERR (previously known as LINC01578) causing suspected overexpression of CHD2

Date of Report

Sep 28, 2021

Description

The participant spent the first 19 days after birth in the neonatal intensive care unit (NICU) because of respiratory distress, feeding issues, low muscle tone (hypotonia) and slow heart rate (bradycardia). She was also found to have a heart defect (atrial septal defect). An initial MRI showed almost complete lack of myelination and enlarged ventricles.  Subsequent MRIs demonstrate diffuse white matter pallor and progressive ventriculomegaly. A diagnosis of Pelizaeus-Merzbacher Like Leukodystrophy (PMLD) was given, but it is now thought that she does not fit any of the known leukodystrophies.

The participant has had many gastrointestinal reflux issues as well as chronic pain and chronic congestion. Her chronic pain results in 5 to 10 breath holding spells per day which have been improved through iron supplementation. She also has flow of urine from the bladder to the kidneys (vesicoureteral reflux), which has resulted in frequent urinary tract infections. She is entirely non-verbal and unable to hold up her head or sit on her own. She has had many abnormal EEG tests from an early age. The participant recently presented with infantile spasms prior to her third birthday which are controlled through Vigabatrin.

Symptoms / Signs
  • Brain abnormalities (EEG with generalized slow activity, cerebral white matter atrophy)
  • Low muscle tone (generalized hypotonia)
  • Global developmental delay
  • Short stature
  • Small head size (microcephaly)
  • Facial differences (long philtrum, deep philtrum, upslanted palpebral fissures, anteverted nares, hypertelorism)
  • Red-colored birthmark (nevus flammeus)
  • Small jaw (micrognathia)
  • Narrow fingertips (tapered distal phalanges of finger)
  • Slow heart rate (bradycardia)
  • Small indentation in the lower back (sacral dimple)
  • Gastroesophageal reflux
  • Flow of urine from bladder to kidneys (vesicoureteral reflux)
  • Club foot (talipes equinovarus)
  • Abnormal movements (abnormal head movements, tongue thrusting)
  • Abnormalities of cerebrospinal fluid (decreased CSF neopterin level, decreased CSF biopterin level)
Current Treatments
  • Bactrim
  • Flonase, Zyrtec – congestion
  • Lansoprazole – gastroesophageal reflux
  • Melatonin – sleeping difficulties
  • Miralax – constipation
  • Nasogastric tube – feeding difficulties
  • Onfi – movement disorder
  • Vigabatrin – Infantile spasms
Prior Treatments
  • Bethanacol – motility
  • Ferritin – iron deficiency
  • Prednisone, topamax – EEG abnormalities
Considered treatments
Previously Considered Diagnoses
  • CDKL5 deficiency
  • FOXG1 syndrome
  • Lysosomal storage disorder
  • Metabolic condition
  • Neurotransmitter disorder
  • Pelizaeus Merzbacher Like Leukodystrophy (PMLD)
  • Sandhoff disease
Other Photographs
Genetic Variants of Interest

Clinicians and researchers believe the following genes are involved in causing the participant’s symptoms (CITED2 variant likely explains the atrial septal defect):

Gene
Inheritance Pattern
Position (hg19)
Transcript
DNA Change
Protein Change
CHD2
Autosomal dominant
chr15:g.93443759G>C
NM_001271.3
c.-367G>C
N/A
CITED2
Autosomal dominant
chr6:g.139694381T>G
NM_006079.4
c.701A>C
p.Glu234Ala
CHASERR (previously known as LINC01578)
Autosomal dominant
chr15:g.93954496_ 93976911del
NC_000015.9
22kbp deletion
N/A
Contact

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