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Published on: August 12, 2020
[GACI syndrome: a case report with a neonatal beginning]
C Freychet1, C Gay1, M-P Lavocat1
1Service de pédiatrie, CHU Nord, avenue Albert-Raymond, 42055 Saint-Étienne, France.
Insights
Generalized arterial calcification of infancy (GACI) and pseudoxanthoma elasticum (PXE) are linked conditions causing arterial and tissue calcifications. This case highlights a patient with GACI who later developed PXE-like symptoms, illustrating their shared pathophysiology.
Area of Science:
- Genetics
- Pediatrics
- Vascular Biology
Background:
- Generalized arterial calcification of infancy (GACI) is a rare, severe autosomal recessive disorder.
- GACI presents with arterial and periarticular calcifications, often leading to fatal cardiovascular complications in infancy.
- Hypophosphatemic rickets (HR) can be a feature of GACI, indicating a potentially milder phenotype.
Abstract:
GACI (generalized arterial calcification of infancy) is a rare autosomal recessive disorder characterized by arterial and periarticular calcifications. Most children die in the first months of life of cardiovascular complications. Hypophosphatemic rickets (HR) resistant to medical treatment may complete the phenotype and is associated with a milder phenotype. This report discusses the case of a girl who presented neonatal ectopic periarticular calcifications with spontaneous regression, and then at the age of 3 years developed HR. There was no clinical improvement after treatment with calcitriol and phosphate, and correction of alkaline phosphatase induced the recurrence of periarticular and tissular calcifications : the treatment was reduced and the bone distortion treated by surgery. GACI diagnosis was confirmed by genetic analysis. At the age of 4.5 years, she developed a retinal abnormality and decreased radial pulse: these clinical signs are usually observed in pseudoxanthoma elasticum (PXE). It is now established that GACI and PXE belong to the same entity characterized by arterial and tissular calcifications of which this original case report is an illustration.
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