Nakajo syndrome

Last updated
Nakajo syndrome
Other namesNodular erythema with digital changes, Amyotrophy-fat tissue anomaly syndrome, Secondary hypertrophic osteoperiostosis with pernio
Autosomal recessive - en.svg
Nakajo syndrome has an autosomal recessive pattern of inheritance.
Specialty Medical genetics

Nakajo syndrome, also called nodular erythema with digital changes, [1] is a rare autosomal recessive congenital disorder first reported in 1939 by A. Nakajo in the offspring of consanguineous (blood relative) parents. [2] [3] The syndrome can be characterized by erythema (reddened skin), loss of body fat in the upper part of the body, and disproportionately large eyes, ears, nose, lips, and fingers. [1]

Contents

Signs and symptoms

Signs of the disease begin during early childhood with individuals developing red, swollen lumps (nodular erythema) on the skin especially during colder weather, frequent fevers, and elongated fingers and toes with widened and rounded tips (clubbing). [4]

Later in childhood, individuals with the disease develop join pain, and joint deformities (contractures) that limit movement predominantly in the hands, wrists, and elbows. They additional have weakness and wasting of muscle and fat loss that worsens over time. This leads to an extremely thin (emaciated) appearance in the face, chest, and arms. [4]  

Other symptoms of Nakajo-Nishimura syndrome are enlarged liver and spleen (hepatosplenomegaly), shortage of red blood cells (anemia), reduced levels of platelet blood cells (thrombocytopenia), and calcification in the basal ganglia area of the brain. There have been cases of intellectual disability in affected individuals. [4]

Nakajo-Nishimura syndrome has overlapping symptoms with joint contractures, muscular atrophy, microcytic anemia, and panniculitis-induced lipodystrophy (JMP) syndrome and chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome. These conditions are all caused by mutations in PSMB8 and characterized by skin abnormalities and lipodystrophy. Although these conditions are considered different diseases, some researchers believe they represent different forms of a single condition. [4]

Genetics

Nakajo syndrome is inherited in an autosomal recessive manner. [3] This means the defective gene responsible for the disorder is located on an autosome, and two copies of the defective gene (one inherited from each parent) are required in order to be born with the disorder. This gene is called PSMB8 and is located on chromosome 6 at 6p21.32. [5] This gene codes for a subunit called immunoproteasomes that are found immune system cells. These cells are crucial for identifying viral proteins. It has been noted that malfunctions in PSMB8 cause the destruction of proteins which leads to muscle degradation and fat loss. The parents of an individual with an autosomal recessive disorder both carry one copy of the defective gene, but usually do not experience any signs or symptoms of the disorder. [4] Although variations in severity has little clinical support, onset of Nakajo syndrome can vary from ages 1–18. [6]

Diagnosis

Typical diagnosis looks for at least five out of eight proposed criteria for Nakajo syndrome: an autosomal recessive inheritance pattern, pernio-like purplish lesions (on hands and feet), ''haunting'' nodular erythema, repetitive spiking fever, long clubbed fingers and toes with joint contractures, progressive upper body lipomuscular atrophy/emaciation, hepatosplenomegaly and basal ganglion calcification on computed tomography (CT) scans. These features are not always apparent until childhood. Histopathologic examination shows focal mononuclear cell infiltration with vasculopathy. Laboratory results include continually elevated C-reactive protein (CRP) levels and hyper-gamma-globulinemia. Autoantibody titers rise as the disease progresses in some but remain negative in others. Molecular genetic testing can detect a disease causing mutation, verifying diagnosis. [7]

Management

Currently, there are no treatments for Nakajo syndrome. However, available treatment options may help alleviate some of the symptoms. Existing steroids may help reduce inflammatory responses. Various immunosuppressive and anti-rheumatic have shown to have little or no temporal response in PRAAS patients. Ultimately, the progressive lipodystrophy caused by Nakajo syndrome continues despite treatment. [8]

Epidemiology

Two affected siblings reported by Tanaka were born from a consanguineous marriage. [9] Though a majority of cases originate in Japan, however two siblings reported by Garg were Portuguese and also born from a consanguineous marriage. [6]

Related Research Articles

<span class="mw-page-title-main">Panniculitis</span> Inflammation of the fatty layer under the skin (panniculus adiposus)

Panniculitis is a group of diseases whose hallmark is inflammation of subcutaneous adipose tissue. Symptoms include tender skin nodules, and systemic signs such as weight loss and fatigue.

<span class="mw-page-title-main">Arthrogryposis</span> Medical condition

Arthrogryposis (AMC) describes congenital joint contracture in two or more areas of the body. It derives its name from Greek, literally meaning 'curving of joints'.

<span class="mw-page-title-main">Aase syndrome</span> Medical condition

Aase syndrome or Aase–Smith syndrome is a rare inherited disorder characterized by anemia with some joint and skeletal deformities. Aase syndrome is thought to be an autosomal dominant inherited disorder. The genetic basis of the disease is not known. The anemia is caused by underdevelopment of the bone marrow, which is where blood cells are formed.

<span class="mw-page-title-main">Behr syndrome</span> Medical condition

Behr syndrome is characterized by the association of early-onset optic atrophy with spinocerebellar degeneration resulting in ataxia, pyramidal signs, peripheral neuropathy and developmental delay.

Farber disease is an extremely rare, progressive, autosomal recessive lysosomal storage disease caused by a deficiency of the acid ceramidase enzyme. Acid ceramidase is responsible for breaking down ceramide into sphingosine and fatty acid. When the enzyme is deficient, this leads to an accumulation of fatty material in the lysosomes of the cells, leading to the signs and symptoms of this disorder.

<span class="mw-page-title-main">Arakawa's syndrome II</span> Medical condition

Arakawa's syndrome II is an autosomal dominant metabolic disorder that causes a deficiency of the enzyme tetrahydrofolate-methyltransferase; affected individuals cannot properly metabolize methylcobalamin, a type of Vitamin B12.

<span class="mw-page-title-main">Micrognathism</span> Condition in which the jaw is small

Micrognathism is a condition where the jaw is undersized. It is also sometimes called mandibular hypoplasia. It is common in infants, but is usually self-corrected during growth, due to the jaws' increasing in size. It may be a cause of abnormal tooth alignment and in severe cases can hamper feeding. It can also, both in adults and children, make intubation difficult, either during anesthesia or in emergency situations.

An immunoproteasome is a type of proteasome that degrades ubiquitin-labeled proteins found in the cytoplasm in cells exposed to oxidative stress and proinflammatory stimuli. In general, proteasomes consist of a regulatory and a catalytic part. Immunoproteasomes are induced by interferon gamma and oxidative stress, which in the cell triggers the transcription of three catalytic subunits that do not occur in the classical proteasome. Another possible variation of proteasome is the thymoproteasome, which is located in the thymus and folds to present peptides to naive T cells.

<span class="mw-page-title-main">Laminopathy</span> Medical condition

Laminopathies are a group of rare genetic disorders caused by mutations in genes encoding proteins of the nuclear lamina. Since the first reports of laminopathies in the late 1990s, increased research efforts have started to uncover the vital role of nuclear envelope proteins in cell and tissue integrity in animals. Laminopathies are a group of degenerative diseases, other disorders associated with inner nuclear membrane proteins are known as nuclear envelopathies.

<span class="mw-page-title-main">Bethlem myopathy</span> Medical condition

Bethlem myopathy is predominantly an autosomal dominant myopathy, classified as a congenital form of limb-girdle muscular dystrophy. There are two types of Bethlem myopathy, based on which type of collagen is affected.

<span class="mw-page-title-main">Marden–Walker syndrome</span> Medical condition

Marden–Walker syndrome (MWS) is a rare autosomal recessive congenital disorder. It is characterized by blepharophimosis, microcephaly, micrognathia, multiple joint contractures, arachnodactyly, camptodactyly, kyphoscoliosis and delayed motor development and is often associated with cystic dysplastic kidneys, dextrocardia, Dandy–Walker malformation and agenesis of corpus callosum.

<span class="mw-page-title-main">X-linked spinal muscular atrophy type 2</span> Medical condition

X-linked spinal muscular atrophy type 2, also known as arthrogryposis multiplex congenita X-linked type 1 (AMCX1), is a rare neurological disorder involving death of motor neurons in the anterior horn of spinal cord resulting in generalised muscle wasting (atrophy). The disease is caused by a mutation in UBA1 gene and is passed in an X-linked recessive manner by carrier mothers to affected sons.

<span class="mw-page-title-main">Lethal congenital contracture syndrome</span> Medical condition

Lethal congenital contracture syndrome 1 (LCCS1), also called multiple contracture syndrome, Finnish type, is an autosomal recessive genetic disorder characterized by total immobility of a fetus, detectable at around the 13th week of pregnancy. LCCS1 invariably leads to prenatal death before the 32nd gestational week. LCCS1 is one of 40 Finnish heritage diseases. It was first described in 1985 and since then, approximately 70 cases have been diagnosed.

Haim–Munk syndrome is a skin disease caused, like Papillon–Lefèvre syndrome, by a mutation in the cathepsin C gene. One of its features is thick curved finger and toenails.

<span class="mw-page-title-main">Roberts syndrome</span> Medical condition

Roberts syndrome, or sometimes called pseudothalidomide syndrome, is an extremely rare autosomal recessive genetic disorder that is characterized by mild to severe prenatal retardation or disruption of cell division, leading to malformation of the bones in the skull, face, arms, and legs.

<span class="mw-page-title-main">Majeed syndrome</span> Medical condition

Majeed syndrome is an inherited skin disorder characterized by chronic recurrent multifocal osteomyelitis, congenital dyserythropoietic anemia and a neutrophilic dermatosis. It is classified as an autoinflammatory bone disorder. The condition is found in people with two defective copies of the LPIN2 gene. LPIN2 encodes lipin-2 which is involved in lipid metabolism. The pathogenesis of this mutation with the clinical manifestations has not been elucidated.

Carrier testing is a type of genetic testing that is used to determine if a person is a carrier for specific autosomal recessive diseases. This kind of testing is used most often by couples who are considering becoming pregnant to determine the risks of their child inheriting one of these genetic disorders.

<span class="mw-page-title-main">CANDLE syndrome</span> Medical condition

Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome is an autosomal recessive disorder that presents itself via various autoinflammatory responses throughout the body, multiple types of skin lesions, and recurrent long-term fever symptoms. The current known cause for the disorder is a mutation in the PSMB8 gene or mutations in other closely related genes. The syndrome was first named and classified in March 2010 after four patients were reviewed with similar symptoms. There have been approximately 30 cases reported in the scientific literature as of 2015.

References

  1. 1 2 Online Mendelian Inheritance in Man (OMIM): Nakajo syndrome - 256040
  2. Nakajo A (1939). "Secondary hypertrophic osteoperiostosis with pernio". J Derm Venerol. (in Japanese). 45: 77–86.
  3. 1 2 Kitano Y, Matsunaga E, Morimoto T, Okada N, Sano S (August 1985). "A syndrome with nodular erythema, elongated and thickened fingers, and emaciation". Archives of Dermatology. 121 (8): 1053–1056. doi:10.1001/archderm.121.8.1053. PMID   4026345.
  4. 1 2 3 4 5 "Nakajo-Nishimura syndrome: MedlinePlus Genetics". medlineplus.gov. Retrieved 2022-03-17.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  5. "PSMB8 proteasome 20S subunit beta 8 [ Homo sapiens (human) ]". NCBI Gene. National Library of Medicine (US), National Center for Biotechnology Information.
  6. 1 2 Garg A, Hernandez MD, Sousa AB, Subramanyam L, Martínez de Villarreal L, dos Santos HG, Barboza O (September 2010). "An autosomal recessive syndrome of joint contractures, muscular atrophy, microcytic anemia, and panniculitis-associated lipodystrophy". The Journal of Clinical Endocrinology and Metabolism. 95 (9): E58–E63. doi:10.1210/jc.2010-0488. PMC   2936059 . PMID   20534754.
  7. "Nakajo Nishimura syndrome | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Retrieved 2022-03-21.
  8. McDermott A, Jacks J, Kessler M, Emanuel PD, Gao L (February 2015). "Proteasome-associated autoinflammatory syndromes: advances in pathogeneses, clinical presentations, diagnosis, and management". International Journal of Dermatology. 54 (2): 121–129. doi: 10.1111/ijd.12695 . PMID   25521013. S2CID   205189155.
  9. Tanaka M, Miyatani N, Yamada S, Miyashita K, Toyoshima I, Sakuma K, et al. (January 1993). "Hereditary lipo-muscular atrophy with joint contracture, skin eruptions and hyper-gamma-globulinemia: a new syndrome". Internal Medicine. 32 (1): 42–45. doi: 10.2169/internalmedicine.32.42 . PMID   8495043. S2CID   39807679.