The Turkish Journal of Pediatrics
2023 , Vol 65 , Num 5
Compound heterozygous mutations in the helicase RTEL1 causing Hoyeraal-Hreidarsson syndrome with Blake`s pouch cyst: a case report
Min He 1 ,GuoLi Lian 1 ,HaiPeng Hu 1 ,Huan He 1 ,Miaomiao Wang 1
1 Department of Pediatric, the First Affiliated Hospital of Xi’an Jiaotong University, Xi ‘an 710061, People’s Republic of China
DOI :
10.24953/turkjped.2022.344
Background. Telomeres inhibit DNA damage response at the ends of the chromosome to suppress cell cycle
arrest as well as ensure genome stability. Dyskeratosis congenita (DC), a telomere-related disease, includes
the classical triad involving oral leukoplakia, dysplastic nails, and lacy reticular pigment in the neck and/or
upper chest. Hoyeraal–Hreidarrson syndrome (HHS), a severe manifestation of DC, frequently occurs during
childhood, and patients with HHS often show short-term survival and thus do not exhibit all mucocutaneous
manifestations or syndromic features.
Case. We report here a patient with HHS characterized by the proband`s clinical attributes, such as growth delay,
bone marrow failure, microcephaly, defects in body development, and the absence of cerebellar hypoplasia
combined with Blake`s pouch cyst. By using exome sequencing, novel compound heterozygous mutations
(c.1451C>T and c.1266+3del78bp) were detected in the RTEL1 (regulator of telomere elongation helicase 1) gene.
Conclusions. The DNA helicase RTEL1 plays a role in genome stability, DNA replication, telomere maintenance,
and genome repair. Terminal restriction fragment length analysis revealed a significantly shorter telomere
length of the proband. Our findings provided evidence that compound heterozygous RTEL1 mutations cause
HHS.
Keywords :
Blake`s pouch cyst, dyskeratosis congenita, telomere length, Hoyeraal-Hreidarsson syndrome
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