Turner syndrome and neurofibromatosis 1: Rare co-existence with important clinical implications / Journal of the ASEAN Federation of Endocrine Societies

@#A 16.5-year-old Indian female presented with secondary amenorrhoea, cubitus valgus, scoliosis and multiple lentigines on the face. Karyotyping revealed mosaic Turner syndrome (TS) with 45, X/46, X iXq. She also had multiple café-au-lait macules and axillary freckles but no neurofibroma and did not fulfil the classic criteria for diagnosis of Neurofibromatosis-1(NF1). Many of her macules were smaller than 15 mm in diameter, which might be due to her hypoestrogenic state. However, exome-sequencing found a pathologic variant consistent with NF1. She was started on daily oral estrogen, and oral progesterone for 10 days every month with close monitoring for neurofibroma and/or glioma expansion. Co-occurrence of NF1 and TS is extremely rare, TS and NF1 can both affect growth and puberty, cause different cutaneous and skeletal deformities, hypertension, vasculopathy and learning disabilities. Our case highlights the need for genetic testing in some cases with NF1 who do not strictly fulfil the NIH diagnostic criteria. We also emphasize the need for close monitoring during therapy with growth hormone, estrogen and progesterone due to the potential risk of tumour expansion in NF1.

Short-term multimodal phototherapy approach in a diabetic ulcer patient

Foot ulcers increase morbidity and mortality in diabetic patients. Due to poor healing factors, surgical wound healing is questionable in diabetic patients. We report a patient with insulin-dependent diabetes mellitus, sensory neuropathy and microangiopathy, who had an infected stump of the right three middle digits and subsequent transmetatarsal amputation. The infected postoperative ulcer was treated with complex phototherapy, including laser and ultraviolet C (UVC) radiations. A total of 23 sessions of low-intensity laser therapy and UVC irradiation were administered over a five-week period. The infected surgical wound healed completely. During the three-month follow-up period, there was no recurrence of the ulcer, although the patient's metabolic profile remained unstable. Multimodal therapy combining UVC and laser may constitute a useful and side-effect-free alternative treatment modality for the induction of wound healing post metatarsal amputation in patients with unhealed diabetic ulcers.