A Case of Myhre syndrome mimicking juvenile scleroderma
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Myhre syndrome is a genetic disorder caused by gain of function mutations in the SMAD Family Member 4 (SMAD4) gene, resulting in progressive, proliferative skin and organ fibrosis. Skin thickening and joint contractures are often the main presenting features of the disease and may be mistaken for juvenile scleroderma.

A case of a 13 year-old female presenting with widespread skin thickening and joint contractures from infancy was reported. She was diagnosed with diffuse cutaneous systemic sclerosis, and treatment with corticosteroids and subcutaneous methotrexate was recommended. There was however disease progression prompting genetic testing. This identified a rare heterozygous pathogenic variant c.1499 T greater than C(p.Ile500Thr) in the SMAD4 gene, suggesting a diagnosis of Myhre syndrome. Securing a molecular diagnosis in this case allowed the cessation of immunosuppression, thus reducing the burden of unnecessary and potentially harmful treatment, and allowing genetic counselling.

Myhre Syndrome is a rare genetic mimic of scleroderma that should be considered alongside several other monogenic diseases presenting with pathological fibrosis from early in life. This case provides an overview of these genetic mimics of scleroderma, and highlights the molecular pathways that can lead to pathological fibrosis. This may provide clues to the pathogenesis of sporadic juvenile scleroderma, and could suggest novel therapeutic targets.

source: https://ped-rheum.biomedcentral.com/articles/10.1186/s12969-020-00466-1#Abs1