Search

The optimum duration of treatment in patients with juvenile idiopathic arthritis (JIA), including enthesitis-related arthritis (ERA), is an area of pivotal concern for both parents and physicians. Novel medicines have managed to achieve remission of this otherwise debilitating condition1; however, issues regarding the duration and the best timing for termination of therapy endure.2 Enthesitis-related arthritis remains one of the most challenging JIA subtypes in terms of drug management and withdrawal. We report the results of a medical records review study aiming to describe the long-term outcome of children with a specific subcategory of ERA, solely treated with a tumor necrosis factor inhibitor (TNFi) (adalimumab [ADA]), in whom treatment was discontinued, following sustained clinical remission, and to identify potential relapse-associated risk factors. © 2022 Lippincott Williams and Wilkins. All rights reserved.

Objective. Aldosterone synthase deficiency (ASD) is a rare, autosomal recessive inherited disease with an overall clinical phenotype of failure to thrive, vomiting, severe dehydration, hyperkalemia, and hyponatremia. Mutations in the CYP11B2 gene encoding aldosterone synthase are responsible for the occurrence of ASD. Defects in CYP11B2 gene have only been reported in a limited number of cases worldwide. Due to this potential life-threatening risk, comprehensive hormonal investigation followed by genetic confirmation is essential for the clinical management of offsprings. Case presentation. We herein describe an unusual case of ASD type II in a neonate with faltering growth as a single presenting symptom. To our knowledge, this is the first Greek case of ASD type II reported with confirmed genetic analysis. Next generation sequencing of her DNA revealed the homozygous mutation p.T185I (ACC-ATC) (c.554C>T) (g.7757C>T) in exon 3 of the CYP11B2 gene in the neonate, inherited from both parents who were heterozygotes for the mutation. Conclusions. Physicians handling neonates with faltering growth, particularly in the initial six weeks of life, should be suspicious of mineralocorticoid insufficiency either as isolated hypoaldosteronism or in the context of congenital adrenal hyperplasia. Essential investigations should be performed and appropriate treatment should be administered promptly without awaiting for the hormonal profile results. Interpretation of the clinical picture and the hormonal profile will guide the analysis of candidate genes. Primary selective hypoaldosteronism is a rare, life threatening disease, but still with an unknown overall population impact. Thus, reporting cases with confirmed gene mutations is of major importance. © 2020 Stayroula Papailiou et al., published by Sciendo 2020.

Mutations in KCNQ2 gene, encoding for voltage-gated K+ channel subunit, may result in a wide spectrum of early-onset epileptic disorders. The phenotype of the disease varies from “benign familial neonatal seizures” to “severe epileptic encephalopathies”. In this report, we present a novel mutation [namely: c.683A>G (p.His228Arg)], as a presumable cause of severe infantile-onset neonatal seizures, in a 3-month old boy. The seizures have been poorly responsive to various pharmacological treatments, with phenytoin and carbamazepine presenting with the most favourable results so far. The study of our patient could help to further clarify the clinical manifestations of KCNQ2 mutations, revealing a previously unreported mutation. © 2019, Turkish Journal of Pediatrics. All rights reserved.