background participants

Participant 199


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Male, age 14, with a weakened immune system (common variable immune deficiency), mitochondrial deficiency (complex I), delayed stomach emptying (gastroparesis), and multiple congenital anomalies.

Date of Report

Apr 12, 2022

Description

The participant was born at 38 weeks after a complicated pregnancy involving preterm labor. There were no complications at the time of birth. At 8 weeks old, he was diagnosed with Shone Complex, a combination of several heart defects (coarctation of the aorta, bicuspid aortic valve, aortic valve stenosis, abnormal mitral valve). His heart abnormalities were later surgically repaired.

As a toddler, the participant was noticeably immunodeficient. He has been hospitalized numerous times for recurring bacterial and viral infections. He was also hospitalized for fevers with unknown origins, and had ear tubes placed to treat recurrent ear infections (otitis media).

At age 7, the participant was diagnosed with a brain abnormality (Arnold-Chiari type I). Two years later, he underwent a tethered cord release procedure. At age 9, he was diagnosed with bladder and urination issues caused by the nervous system (neurogenic bladder). He also has a history of weakened wall of larynx and bronchial tubes (laryngomalacia and bronchomalacia).

The participant continues to have fevers of unknown origin multiple times per year. He receives formula through his J tube, but TPN is his main source of nutrition.

Notably, the participant was previously diagnosed with 16p11.2 microduplication syndrome that was maternally inherited. He also was diagnosed with weakened connective tissue (Ehlers Danlos syndrome type 3) and mitochondrial deficiency (complex I).

Symptoms / Signs
  • Weakened immune system (common variable immune deficiency)
  • Mitochondrial deficiency (complex I)
  • Delayed stomach emptying (gastroparesis)
  • Brain abnormalities (ventriculomegaly, Arnold-Chiari type I malformation)
  • Tethered cord
  • Recurrent ear infections (otitis media)
  • Heart defects (coarctation of the aorta, bicuspid aortic valve, aortic valve stenosis)
  • Weakened walls of the larynx (laryngomalacia)
  • Weakened walls of the bronchial tubes (bronchomalacia)
  • Gap between larynx and esophagus (laryngeal cleft)
  • Delayed stomach emptying (gastroparesis)
  • Progressive GERD
  • Bowel obstruction (Meckel’s diverticulum)
  • Bladder and urination issues, caused by the nervous system (neurogenic bladder)
  • Knock knee (genu valgum)
  • Lower limb asymmetry
  • Anemia
Current Treatments
  • Amitriptyline
  • Aspirin
  • Bipap
  • Budesonide
  • Cetrizine
  • Cholecalciferol
  • Clonidine
  • CoQ10
  • Diazepam
  • Dicyclomine
  • Famotidine
  • Fludrocortisone
  • Fluticasone
  • GJ-tube
  • IV iron sucrose
  • Levocarnitine
  • Losartan
  • Lyrica
  • Melatonin
  • Multivitamin
  • N-Acetyl Cysteine
  • Nexium
  • Pedialyte
  • Pregabalin
  • Pressure Equalization (PE) tubes
  • Pulmicort
  • Oxycodone
  • Riboflavin
  • Senna
  • Simethicone
  • Sodium chloride
  • Total parenteral nutrition (TPN)
  • Vest treatment
  • Vitamin D3
  • Zofran
Prior Treatments
  • Aortic valve repair
  • Aortic valve repleacement
  • Balloon angioplasty
  • Cleft repair
  • Decompression surgery
  • Heel cord lengthening
  • Nissen procedure
  • Right ilio-femoral bypass surgery
  • IVIG infusions
  • Tethered cord release
Considered treatments
Previously Considered Diagnoses
  • Microdeletion/microduplication syndromes
  • Mitochondrial disease
  • Myelodysplastic syndrome
Other Photographs
Genetic Variants of Interest

Clinicians and researchers are investigating the following genetic changes to see if they are causing the participant’s symptoms:

Gene
Inheritance Pattern
Position (hg19)
Transcript
DNA Change
Protein Change
Autosomal Recessive
chr16:g.89862376G>A
NM_000135.3
c.944C>T
p.Pro315Leu
Autosomal Recessive
chr19:g.41119932G>C
NM_001042544.1
c.2869G>C
p.Ala957Pro
Unknown
chr6:g.170047864C>T & chr6:g.170070759G>T
NM_182552.5
c.1657+5G>A & c.362C>A
N/A & p.Ser121Ter
ADK
Autosomal Recessive
chr10:g.764300001A>G
NM_006721.3
c.938A>G
p.Asn313Ser
Autosomal Recessive
chr2:g.58468412G>A
NM_001114636.1
c.37C>T
p.Pro13Ser
Autosomal Recessive
chr2:g.204807979T>C
NM_012092.4
c.58+6384T>C
N/A
Autosomal Recessive
chr4:g.64877827C>T
NM_005956.3
c.146C>T
p.Ser49Phe
Autosomal Recessive
chr11:g.36596970del
NM_000448.2
c.2116delA
p.Arg706GlyfsTer44
Autosomal Recessive
chr1:g.198668827A>G
NM_002838.4
c.433A>G
p.Ile145Val
Contact

If this participant sounds like you or someone you know, please contact us!

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