Abstract

Introduction: DiGeorge syndrome is a heterogenous disorder with various clinical presentations. Common features include thymic hypoplasia, T cell lymphopenia, conotruncal heart defects, facial dysmorphism, cleft palate, developmental delay, and hypoparathyroidism. The severity of this condition varies, however typical presentation includes congenital heart defects and characteristic facial features. Isolated hypocalcemia in DiGeorge syndrome is rarely seen in neonates but rather as the sole manifestation in older teenagers or adults.
Aim: To report a case of an atypical presentation of DiGeorge syndrome.
Results: We report here a case of an infant who was diagnosed with DiGeorge syndrome, with seizures being the only clinical manifestation displayed by the patient. He was found to have low T cell receptor excision circle levels on a newborn screen (NBS) for severe combined immunodeficiency (SCID). He did not have facial dysmorphism nor cardiac defect.
Conclusion: Our case shows that severe hypocalcemia can be the only presenting symptom in DiGeorge syndrome. Based on this case, we recommend physicians test for calcium levels and PTH at the first encounter with a patient who screened positive during NBS for SCID.
Statement of Novelty: We describe an infant with DiGeorge syndrome who presented with severe hypocalcemia.

Formats available

You can view the full content in the following formats:

REFERENCES

Aubry M., Demczuk S., Desmaze C., Aikem M., Aurias A., Julien J.P., and Rouleau G.A. 1993. Isolation of a zinc finger gene consistently deleted in DiGeorge syndrome. Hum. Mol. Genet. 2: 1583–7.
Barry J.C., Crowley T.B., Jyonouchi S., Heimall J., Zackai E.H., Sullivan K.E., and Mcdonald-Mcginn D.M. 2017. Identification of 22q11.2 Deletion Syndrome via Newborn Screening for Severe Combined Immunodeficiency. J. Clin. Immunol. 37: 476–85.
Biggs C.M., Haddad E., Issekutz T.B., Roifman C.M., and Turvey S.E. 2017. Newborn screening for severe combined immunodeficiency: a primer for clinicians. CMAJ, 189: E1551–7.
Botto L.D., May K., Fernhoff P.M., Correa A., Coleman K., Rasmussen S.A., Merritt R.K., O’leary L.A., Wong L.Y., Elixson E.M., Mahle W.T., and Campbell R.M. 2003. A population-based study of the 22q11.2 deletion: phenotype, incidence, and contribution to major birth defects in the population. Pediatrics, 112: 101–7.
Burn J. 1999. Closing time for CATCH22. J. Med. Genet. 36: 737–8.
Burn J., Takao A., Wilson D., Cross I., Momma K., Wadey R., Scambler P., and Goodship J. 1993. Conotruncal anomaly face syndrome is associated with a deletion within chromosome 22q11. J. Med. Genet. 30: 822–4.
Cabrer M., Serra G., Gogorza M.S., and Pereg V. 2018. Hypocalcemia due to 22q11.2 deletion syndrome diagnosed in adulthood. Endocrinol. Diabetes Metab. Case Rep. 2018: 17-0140.
Chieffo C., Garvey N., Gong W., Roe B., Zhang G., Silver L., Emanuel B.S., and Budarf M.L. 1997. Isolation and characterization of a gene from the DiGeorge chromosomal region homologous to the mouse Tbx1 gene. Genomics, 43: 267–77.
Demczuk S., Thomas G., and Aurias A. 1996. Isolation of a novel gene from the DiGeorge syndrome critical region with homology to Drosophila gdl and to human LAMC1 genes. Hum. Mol. Genet. 5: 633–8.
Fukushima Y., Ohashi H., Wakui K., Nishida T., Nakamura Y., Hoshino K., Ogawa K., and Oh-Ishi T. 1992. DiGeorge syndrome with del(4)(q21.3q25): possibility of the fourth chromosome region responsible for DiGeorge syndrome. (Abstract). Am. J. Hum. Genet, 51 (suppl.): A80.
Goodship J., Cross I., Liling J., and Wren C. 1998. A population study of chromosome 22q11 deletions in infancy. Arch. Dis. Child. 79: 348–51.
Grazioli S., Bennett M., Hildebrand K.J., Vallance H., Turvey S.E., and Junker A.K. 2014. Limitation of TREC-based newborn screening for ZAP70 Severe Combined Immunodeficiency. Clin. Immunol. 153: 209–10.
Greenberg F., Elder F.F., Haffner P., Northrup H., and Ledbetter D.H. 1988. Cytogenetic findings in a prospective series of patients with DiGeorge anomaly. Am. J. Hum. Genet. 43: 605–11.
Kwan A., Abraham R.S., Currier R., Brower A., Andruszewski K., Abbott J.K., Baker M., Ballow M., Bartoshesky L.E., Bonilla F.A., Brokopp C., Brooks E., Caggana M., Celestin J., Church J.A., Comeau A.M., Connelly J.A., Cowan M.J., Cunningham-Rundles C., Dasu T., Dave N., De La Morena M.T., Duffner U., Fong C.T., Forbes L., Freedenberg D., Gelfand E.W., Hale J.E., Hanson I.C., Hay B.N., Hu D., Infante A., Johnson D., Kapoor N., Kay D.M., Kohn D.B., Lee R., Lehman H., Lin Z., Lorey F., Abdel-Mageed A., Manning A., Mcghee S., Moore T.B., Naides S.J., Notarangelo L.D., Orange J.S., Pai S.Y., Porteus M., Rodriguez R., Romberg N., Routes J., Ruehle M., Rubenstein A., Saavedra-Matiz C.A., Scott G., Scott P.M., Secord E., Seroogy C., Shearer W.T., Siegel S., Silvers S.K., Stiehm E.R., Sugerman R.W., Sullivan J.L., Tanksley S., Tierce M.L.T., Verbsky J., Vogel B., Walker R., Walkovich K., Walter J.E., Wasserman R.L., Watson M.S., Weinberg G.A., Weiner L.B., Wood H., Yates A.B., Puck J.M., and Bonagura V.R. 2014. Newborn screening for severe combined immunodeficiency in 11 screening programs in the United States. JAMA, 312: 729–38.
Kwan A. and Puck J.M. 2015. History and current status of newborn screening for severe combined immunodeficiency. Semin Perinatol, 39: 194–205.
Maalouf N.M., Sakhaee K., and Odvina C.V. 2004. A case of chromosome 22q11 deletion syndrome diagnosed in a 32-year-old man with hypoparathyroidism. J. Clin. Endocrinol. Metab. 89: 4817–20.
Mandola A.B., Reid B., Sirror R., Brager R., Dent P., Chakroborty P., Bulman D.E., and Roifman C.M. 2019. Ataxia Telangiectasia Diagnosed on Newborn Screening-Case Cohort of 5 Years’ Experience. Front. Immunol. 10: 2940.
Mcdonald-Mcginn D.M., Tonnesen M.K., Laufer-Cahana A., Finucane B., Driscoll D.A., Emanuel B.S., and Zackai E.H. 2001. Phenotype of the 22q11.2 deletion in individuals identified through an affected relative: cast a wide FISHing net! Genet Med. 3: 23–9.
Molsted K., Boers M., and Kjaer I. 2010. The morphology of the sella turcica in velocardiofacial syndrome suggests involvement of a neural crest developmental field. Am. J. Med. Genet. 152A: 1450–7.
Morrow B.E., Mcdonald-Mcginn D.M., Emanuel B.S., Vermeesch J.R., and Scambler P.J. 2018. Molecular genetics of 22q11.2 deletion syndrome. Am. J. Med. Genet. 176: 2070–81.
Puck J.M. 2012. Laboratory technology for population-based screening for severe combined immunodeficiency in neonates: the winner is T-cell receptor excision circles. J. Allergy Clin. Immunol. 129: 607–16.
Reid B.E., Ovadia A., and Dinur Schejter Y. 2017. Managing Newborn Screening for SCID in a Referral Centre. LymphoSign J. 4(2).
Scott O., Garkaby J., Willett-Pachul J., Mandola A.B., and Pasternak Y. 2021. A novel splice site variant in FOXN1 in a patient with abnormal newborn screening for severe combined immunodeficiency and congenital lymphopenia. LymphoSign Journal, 8: 1–4.
Shashi V., Keshavan M.S., Howard T.D., Berry M.N., Basehore M.J., Lewandowski E., and Kwapil T.R. 2006. Cognitive correlates of a functional COMT polymorphism in children with 22q11.2 deletion syndrome. Clin. Genet. 69: 234–8.
Shprintzen R.J., Goldberg R.B., Lewin M.L., Sidoti E.J., Berkman M.D., Argamaso R.V., and Young D. 1978. A new syndrome involving cleft palate, cardiac anomalies, typical facies, and learning disabilities: velo-cardio-facial syndrome. Cleft. Palate. J. 15: 56–62.
Vogels A., Schevenels S., Cayenberghs R., Weyts E., Van Buggenhout G., Swillen A., Van Esch H., De Ravel T., Corveleyn P., and Devriendt K. 2014. Presenting symptoms in adults with the 22q11 deletion syndrome. Eur. J. Med. Genet. 57: 157–62.
Zammit A., Grech Marguerat D., Psaila J., and Attard A. 2013. DiGeorge Syndrome Presenting as Hypocalcaemia-Induced Seizures in Adulthood. Clin. Med. Case Rep. 2013: 1–4.

Information & Authors

Information

Published In

cover image LymphoSign Journal
LymphoSign Journal
Volume 9Number 2June 2022
Pages: 52 - 56

History

Received: 9 May 2022
Accepted: 22 May 2022
Accepted manuscript online: 24 May 2022
Version of record online: 24 May 2022

Authors

Affiliations

Jenny Garkaby [email protected]
Division of Clinical Immunology and Allergy, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, ON
Laura Edith Abrego Fuentes
Division of Clinical Immunology and Allergy, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, ON
Jessica Willett Pachul
Division of Clinical Immunology and Allergy, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, ON
Abby Watts-Dickens
Newborn Screening Program, Department of Clinical and Metabolic Genetics, Hospital for Sick Children and University of Toronto, Toronto, ON
Meghan Fraser
Newborn Screening Program, Department of Clinical and Metabolic Genetics, Hospital for Sick Children and University of Toronto, Toronto, ON

Metrics & Citations

Metrics

Other Metrics

Citations

Cite As

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

Cited by

1. Management of newborn screening for severe combined immunodeficiency at a quaternary referral centre—an updated algorithm

View Options

View options

PDF

View PDF

Full Text

View Full Text

Get Access

Login options

Check if you access through your login credentials or your institution to get full access on this article.

Subscribe

Click on the button below to subscribe to LymphoSign Journal

Purchase options

Purchase this article to get full access to it.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

Media

Media

Other

Tables

Share Options

Share

Share the article link

Share on social media