Síndrome de Kabuki con artritis reumatoide: primer caso reportado / Kabuki syndrome with rheumatoid arthritis: first case reported

Resumen El síndrome de Kabuki (SK) es un trastorno congénito descrito por primera vez en 1981 por Niikawa y Kuroki en Japón, del cual se han publicado cerca de 400 casos en el mundo. Las personas con este síndrome presentan rasgos faciales peculiares, alteraciones musculoesqueléticas, retardo mental, cardiopatías congénitas, compromiso renal, alteración en los dermatoglifos y talla baja. Aunque la asociación entre el SK y las enfermedades autoinmunes está documentada, la evidencia reciente no ha demostrado a la fecha su asociación con artritis reumatoide (AR). Presentamos la descripción del caso de una paciente de 18 años con SK que consultó al Servicio de Reumatología Infantil del Hospital General de Niños Pedro de Elizalde por dolor en el tobillo izquierdo de 10 meses de evolución a quien se le realizó diagnóstico de AR.

Abstract Kabuki syndrome (KS) is a congenital disorder. It was first described in 1981 by Niikawa and Kuroki in Japan and nearly 400 cases have been published worldwide. People with this syndrome present peculiar facial features, musculoskeletal alterations, mental retardation, congenital heart disease, kidney disease, dermatoglyphics alteration and short stature. Although the association between KS and autoimmune diseases is documented, recent evidence has not demonstrated to date its association with rheumatoid arthritis (RA). We present the description of the case of an 18-year-old patient with KS who consulted the Children's Rheumatology Service of the Pedro de Elizalde Children's Hospital due to pain in the left ankle of 10 months' duration. The patient was diagnosed with RA.

Dental Findings in Kabuki Syndrome: A Systematic Review for Dentistry / Hallazgos dentales en el síndrome de Kabuki: Una revisión sistemática para la odontología

Abstract: Kabuki syndrome consists in a series of congenital anomalies involving intellectual disability, hypotonia, and facial and body dysmorphism. In addition to these cardinal signs, craniofacial and dental changes are frequently observed, although they are not fully understood. Thus, the aim of this article is to present the dental findings in patients with Kabuki syndrome. This is a systematic review developed according to the PRISMA protocol. A search strategy with descriptors ("kabuki syndrome" AND "dentistry") was applied to six databases. As inclusion criteria, we selected clinical case reports that addressed dental findings in one or more patients with Kabuki syndrome between 1999 and 2019, without restrictions regarding gender, age or language. Data collection in all databases was performed by a calibrated evaluator and titles, abstracts and full-text studies were systematically analyzed. Eleven case reports that fit the proposed inclusion criteria were found. After the qualitative synthesis, teeth absence or agenesis were the most reported findings, being observed by nine authors. Less frequent dental findings in patients with this syndrome are taurodontism, microdontia, fusion, gemination and conical or screwdriver-shaped teeth. In fact, when any syndrome or genetic condition is related to manifestations of dental interest, the dental surgeon should be able to investigate them, especially teeth agenesis or absence. For this reason, the dentist should be aware of the manifestations of Kabuki syndrome, contributing to patients' understanding and management.

Resumen: El síndrome de Kabuki consiste en una serie de anomalías congénitas que involucran discapacidad intelectual, hipotonía y dismorfismo facial y corporal. Además de estos signos cardinales, con frecuencia se observan cambios craneofaciales y dentales, aunque no se entienden completamente. Por lo tanto, el objetivo de este artículo es presentar los hallazgos dentales en pacientes con síndrome de Kabuki. Esta es una revisión sistemática desarrollada de acuerdo con el protocolo PRISMA. Se aplicó una estrategia de búsqueda con descriptores ("síndrome de kabuki" AND "odontología") a seis bases de datos. Como criterios de inclusión, seleccionamos informes de casos clínicos que abordaban los hallazgos dentales en uno o más pacientes con síndrome de Kabuki entre 1999 y 2019, sin restricciones de género, edad o idioma. La recolección de datos en todas las bases de datos fue realizada por un evaluador calibrado y los títulos, resúmenes y estudios de texto completo fueron analizados sistemáticamente. Se encontraron once informes de casos que se ajustan a los criterios de inclusión propuestos. Después de la síntesis cualitativa, la ausencia de dientes o la agenesia fueron los hallazgos más reportados, siendo observados por nueve autores. Los hallazgos dentales menos frecuentes en pacientes con este síndrome son taurodoncia, microdoncia, fusión, geminación y dientes cónicos o con forma de destornillador. De hecho, cuando cualquier síndrome o condición genética se relaciona con manifestaciones de interés dental, el cirujano dental debe poder investigarlas, especialmente la agenesia o ausencia de los dientes. Por esta razón, el dentista debe ser consciente de las manifestaciones del síndrome de Kabuki, lo que contribuye a la comprensión y el manejo de los pacientes.

A case report of Kabuki syndrome with infantile spasm and literature review / 解放军医学杂志

Objective Through literature review to retrospectively study the clinical characteristics, treatment and prognosis of Kabuki syndrome with infantile spasm. Methods The clinical data of a case of Kabuki syndrome with infantile spasm hospitalized at the first medical center of Chinese PLA General Hospital in August 2019 were retrospectively analyzed, search on PubMed, CNKI, Wanfang Medical Online and online Mendelian Inheritance in Man (OMIM), to summarize the clinical data of Kabuki syndrome with infantile spasm and to explore its relationship with genotypes. Results A boy, 1 year and 7 months old, was admitted for "growth lag, intermittent convulsions for more than 1 year and 1 month". His growth and development were generally backward, had microcephaly, short stature and spasms, magnetic resonance imaging of brain showed normal, the thyroid hormone and growth hormone levels were normal, genetic analysis revealed a denovo frameshift mutation in KDM6A gene (c.2170-c.2171 delAT, p.I724Ifs∗5), electroencephagram showed hypsarrhuthmia, with a series of convulsions, diagnosed as "infantile spasm; Kabuki syndrome", after treating with ACTH, the spasms was completely controlled, multiple reexamination of EEG significantly improved. A total of 16 English literatures and 1 Chinese literature were obtained. There were 48 children had been diagnosed as Kabuki syndrome with epilepsy, including 6 children as Kabuki syndrome and infantile spasm. Among the above 6 cases, only 2 genetic test results were reported, 1 was missense mutation of KMT2D gene (c.96c >G, p.apsp32glu), and 1 was frameshift mutation of KDM6A gene (c.2515_2518del, p.apsn839valfs). Conclusion The new frameshift mutation of KDM6A gene (c.2170-c.2171delAT) in this child could lead to infantile spasm of Kabuki syndrome. Kabuki syndrome could be associated with infantile spasms. If spasm occurs and accompanied by a special face, Kabuki syndrome needs to be considered, gene sequencing should be performed if necessary, early treatment can completely control infantile spasms in all children with Kabuki syndrome, the abnormal of EEG could back to normal, will have a favorable prognosis.

Diagnosis and Management of Hip Dislocation in Patients with Kabuki Syndrome

BACKGROUND: Kabuki syndrome is a rare genetic disorder characterized by distinct dysmorphic facial features, growth deficiency, intellectual disabilities, unusual dermatoglyphic patterns, and skeletal abnormalities. The incidence of hip dislocation in Kabuki syndrome ranges from 18% to 62%. We reviewed the outcomes of management of hip dislocations in patients with Kabuki syndrome with special attention to the diagnostic processes for hip dislocation and Kabuki syndrome. METHODS: Among 30 patients with mutation-confirmed Kabuki syndrome, we selected six patients who had hip dislocations and reviewed their medical records and plain radiographs. The modes of presentation and diagnostic processes for both hip dislocations and Kabuki syndrome were investigated. The management and treatment outcomes of hip dislocations in patients with Kabuki syndrome were evaluated. RESULTS: The average age of patients at the time of diagnosis of hip dislocation was 7.7 months (range, 1 week to 22 months). None of the patients were diagnosed as having Kabuki syndrome at that time. Two patients were treated with a Pavlik harness; one, with closed reduction; two, with open reduction and later pelvic and/or femoral osteotomies; and one, with open reduction combined with pelvic osteotomy. The patients were followed up for 5.8 years on average (range, 2.0 to 10.5 years). The radiologic outcome was graded as Severin IA or IB for three patients who were older than 6 years at the latest follow-up (mean age, 9.9 years; range, 7.8 to 12.4 years). In the remaining three patients younger than 6 years (mean age, 3.8 years; range, 2.7 to 5.3 years), the lateral center edge angle was more than 15°. The clinical diagnosis of Kabuki syndrome was made during follow-up after hip dislocation treatment and confirmed by mutational analysis at a mean age of 4.7 years. The mean interval between the diagnosis of hip dislocation and Kabuki syndrome was 4.0 years. CONCLUSIONS: The management of hip dislocation by conservative or surgical method showed successful results. Awareness of Kabuki syndrome could lead to an early diagnosis of this rare disease in patients with hip dislocation and allow for early detection of other underlying conditions and multidisciplinary management.

Primary Amenorrhea In Kabuki Syndrome: A Case Report

Kabuki syndrome also called as Niikawa Kuroki syndrome is a paediatric congenital disorder characterised bydistinctive facial features, skeletal anomalies, short stature, dermatoglyphic abnormalities and mentalretardation. This syndrome usually manifests with precocious puberty. We are presenting a case of Kabukisyndrome from the South-Indian population with primary amenorrhea for the first time. Further, the clinicalfeatures had considerable overlap with Turner syndrome, and chromosomal analysis revealed the presence ofring (X) chromosome with 45,X karyotype.

Clinical and laboratory characteristics and genetic diagnosis of Kabuki syndrome / 中华儿科杂志

Objective@#To investigate the clinical features, laboratory characteristics and genetic diagnosis of Kabuki syndrome (KS).@*Methods@#Between September 2014 and September 2016, seven children with clinically diagnosed KS from the neurology department, Beijing Children Hospital, Capital Medical University were included in this study. Three of them were male and 4 were female aged from 19 days to 6 years and 4 months with a median age of 3 years and 1 month. The clinical features, laboratory and imaging materials, gene tests were analyzed prospectively.@*Results@#Clinical manifestation: cephalofacial anomaly: all seven cases had unusual facies presented as long palpebral fissures, eversion of the lateral third of lower eyelids, arched eyebrow with brow sparse, epicanthus, orbital hypertelorism, short columella with broad and depressed nasal tip; six cases presented with palatal arch deformity; four cases presented with ptosis; three cases presented with dental abnormalities and hearing impairment respectively; two cases presented with strabismus and earlap malformation respectively; one case presented with amblyopia. Six cases presented with skeletal anomalies. Six cases presented with dermatoglyphic anomalies. All cases presented with mild to moderate mental retardation. Three cases presented with short stature. Four cases presented with cardiac abnormalities. Three cases presented with epileptic seizures. Others: three cases presented with dystonia and neonatal hyperbilirubinemia respectively; two cases presented with feeding problem and hypoglycemia respectively; one case presented with micropenis and fetal finger pads respectively. All seven patients received magnetic resonance imaging (MRI) tests, and none demonstrated an abnormal finding. Five patients received electroencephalogram (EEG) tests, and three of them presented with seizures and EEG abnormalities. Five patients received genetic testing and all presented with KMT2D heterozygous mutations which were new mutations proved by parents validation (three cases were nonsense mutations, one was frameshift mutation, one was missense mutation). All patients received rehabilitation training and symptomatic treatments. Three patients presented with epileptic seizures received antiepileptic therapy. At a median follow-up of 11 months (from 4 months to 2 years), one patient died, one lost to follow-up and five had improved intellectual and physical development. Epileptic seizures were controlled or reduced significantly in three patients presented with epileptic seizures.@*Conclusions@#KS is a multisystem disease with complicated manifestations, which needs a combination of various diagnosis and treatments. Genetic testing can help determine the diagnosis. Unusual facies and mental retardation are the main clinical features and diagnostic clue. It is important to improve prognosis through increasing the knowledge of KS, early diagnosis, and treatment.

Diagnosis and treatment of Kabuki syndrome and its recent progress in molecular mechanisms / 国际儿科学杂志

Kabuki syndrome(KS),also called kabuki make-up syndrome,is characterized by backward growth retardation,skeletal developmental delay,major facial dysmorphic features,multi-organ abnormalities and abnormal dermatoglyphic pattern and mild or moderate mental retardation.For the molecular genetic pathogenesis of KS,KTM2D and KDM6A gene mutations have been identified as pathogenic genes of KS,which regulate the gene expression through chromatin remodelling and histone modification.At present,the etiology and pathogenesis of KS are still unknown.There is no useful biochemical index and standard radiographic findings for the diagnosis of KS.Molecular genetic diagnosis is still to be explored.Currently,the diagnosis of KS is mainly based on five cardinal manifestations:a peculiar face,skeletal anomalies,dermatoglyphic abnormalities,mild to moderate mental retardation and postnatal growth deficiency.For these patients,it can reach a better prognosis the by clinical early detection,early diagnosis,early intervention,as well as improving the growth level,symptomatic treatment,active prevention and treatment of complications as far as possible.

Kabuki syndrome:two case report / 临床儿科杂志

Objective To summarize the clinical features and genetic diagnosis of Kabuki syndrome. Methods The clinical data of Kabuki syndrome in 2 children were retrospectively analyzed. Results Both of them were male and over 1 year old. They had special facial features and febrile convulsion. Gene detection indicated that both of them had mutation in KMT2D (or MLL2) gene, but the clinical phenotypes were different. Conclusion Children with clinically suspected Kabuki syndrome can be confirmed by gene detection.

Kabuki syndrome: clinical and molecular characteristics / 소아과

Kabuki syndrome (KS) is a rare syndrome characterized by multiple congenital anomalies and mental retardation. Other characteristics include a peculiar facial gestalt, short stature, skeletal and visceral abnormalities, cardiac anomalies, and immunological defects. Whole exome sequencing has uncovered the genetic basis of KS. Prior to 2013, there was no molecular genetic information about KS in Korean patients. More recently, direct Sanger sequencing and exome sequencing revealed KMT2D variants in 11 Korean patients and a KDM6A variant in one Korean patient. The high detection rate of KMT2D and KDM6A mutations (92.3%) is expected owing to the strict criteria used to establish a clinical diagnosis. Increased awareness and understanding of KS among clinicians is important for diagnosis and management of KS and for primary care of KS patients. Because mutation detection rates rely on the accuracy of the clinical diagnosis and the inclusion or exclusion of atypical cases, recognition of KS will facilitate the identification of novel mutations. A brief review of KS is provided, highlighting the clinical and genetic characteristics of patients with KS.

The strong association of left-side heart anomalies with Kabuki syndrome / 소아과

PURPOSE: Kabuki syndrome is a multiple congenital malformation syndrome, with characteristic facial features, mental retardation, and skeletal and congenital heart anomalies. However, the cardiac anomalies are not well described in the Korean population. We analyzed the cardiac anomalies and clinical features of Kabuki syndrome in a single tertiary center. METHODS: A retrospective analysis was conducted for a total of 13 patients with Kabuki syndrome. RESULTS: The median age at diagnosis of was 5.9 years (range, 9 days to 11 years and 8 months). All patients showed the characteristic facial dysmorphisms and congenital anomalies in multiple organs, and the diagnosis was delayed by 5.9 years (range, 9 days to 11 years and 5 months) after the first visit. Noncardiac anomalies were found in 84% of patients, and congenital heart diseases were found in 9 patients (69%). All 9 patients exhibited left-side heart anomalies, including hypoplastic left heart syndrome in 3, coarctation of the aorta in 4, aortic valve stenosis in 1, and mitral valve stenosis in 1. None had right-side heart disease or isolated septal defects. Genetic testing in 10 patients revealed 9 novel MLL2 mutations. All 11 patients who were available for follow-up exhibited developmental delays during the median 4 years (range, 9 days to 11 years 11 months) of follow-up. The leading cause of death was hypoplastic left heart syndrome. CONCLUSION: Pediatric cardiologist should recognize Kabuki syndrome and the high prevalence of left heart anomalies with Kabuki syndrome. Genetic testing can be helpful for early diagnosis and counseling.

Presentación de un paciente con síndrome Kabuki / Presentation of a Patient with Kabuki Syndrome

El síndrome Kabuki es una enfermedad genética poco frecuente, caracterizada por discapacidad intelectual, facie peculiar y múltiples anomalías congénitas. Fue descrita en Japón en 1981 por Niikawa y Kuroki; en un inicio se concibe como exclusiva de ese país, donde se estima que su frecuencia es de 1/32000. En la actualidad se han descrito casos procedentes de otras latitudes. Existe un amplio espectro de problemas congénitos asociados al síndrome de Kabuki, con grandes diferencias entre unos y otros individuos. Algunos de los problemas más comunes son defectos cardíacos (30 %), anomalías del tracto urinario, pérdida de audición (50 %), hipotonía y deficiencias de crecimiento postnatal (83 %). En este trabajo se describió un niño de tres años, que habita en el municipio Gibara y presentó los signos principales descritos en esta afección. Al ser una enfermedad de descripción reciente, es importante su delineación clínica para el asesoramiento genético con fines preventivos.

Kabuki syndrome is a rare disease of genetic origin, characterized by varying degrees of intellectual disability, quirky facie and multiple congenital anomalies. It was described in Japan in 1981 by Niikawa and Kuroki; is initially conceived as unique to that country, where an estimated frequency is 1/32000. At present there have been reports from other latitudes. There is a wide spectrum of congenital problems associated with Kabuki syndrome, with big differences between them and other individuals. Some of the most common problems are heart defects (30 %), urinary tract abnormalities, hearing loss (50 %), hypotonia, and postnatal growth deficiency (83 %). In this work, a three -year- old boy, who lives in the Gibara municipality and presented the main signs described for this condition was presented. Being a newly described disease, its clinical delineation is important for genetic counseling for preventive purposes.

Diagnóstico clínico en el síndrome de Kabuki: fenotipo y anomalías asociadas en dos casos nuevos / Clinical diagnosis of Kabuki syndrome: phenotype and associated abnormalities in two new cases

El síndrome de Kabuki es una entidad génica caracterizada por discapacidad intelectual asociada con múltiples anomalías sistémicas. El diagnóstico es fundamentalmente clínico y se basa en dismorfas faciales típicas, anomalías esqueléticas menores, persistencia de las almohadillas del pulpejo de los dedos y défcit de crecimiento posnatal. Otros hallazgos incluyen cardiopatía congénita, anomalías genitourinarias, fisura de paladar y/o labial, atresia anal y défcits funcionales, como mayor susceptibilidad a infecciones, enfermedades autoinmunes y endocrinológicas e hipoacusia. El objetivo de este trabajo es describir dos pacientes con diagnóstico clínico de síndrome de Kabuki, destacando los hallazgos fenotípicos y malformaciones asociadas.

Kabuki syndrome is a genetic entity with multiple anomalies associated with intellectual disability. The clinical diagnosis is based on typical facial features, minor skeletal abnormalities, fnger pads, and postnatal growth defcit. Other fndings may include congenital heart disease, genitourinary anomalies, oral clefts, anal atresia, increased susceptibility to infections, autoimmune and endocrine disease and hearing loss. The objective of this paper is to describe two patients with clinical diagnosis of Kabuki syndrome, highlighting the phenotypic fndings and associated malformations.

Espectro fenotípico da síndrome de Kabuki em 23 pacientes brasileiros / Phenotypic spectrum of Kabuki syndrome in 23 Brazilian patients

Catalogar a variabilidade fenotípica dos pacientes com síndrome de Kabuki atendidos no Núcleo de Genética da Secretaria de Estado de Saúde do Distrito Federal, e comparar os resultados com os dados disponíveis na literatura.

To catalog the phenotypic variability of patients with Kabuki syndrome seen at the Clinical Genetics Service of Secretaria de Estado de Saúde do Distrito Federal, and to compare the results with data available in the literature.

Descrição de uma forma autossômica dominante de síndrome de Kabukipor mutação no gene MLL2 / Description of an autosomal dominant form of Kabuki syndrome by mutationin MLL2 gene

Objetivos: Apesar de existirem mais de 400 casos de síndrome de Kabuki descritos na literatura, pensa-se que a síndrome seja subdiagnosticada. A maioria dos casos ocorre de forma esporádica, mas são descritos alguns casos de transmissão familiar autossômica dominante. Descrevem-se aqui três casos identificados na mesma família.Descrição dos casos: Uma família (mãe e dois filhos) foi diagnosticada com síndrome de Kabuki. Os três pacientes apresentam as características típicas (aparência facial característica, anomalias musculoesqueléticas, déficit cognitivo, atraso de crescimento pós-natal e padrão dermatoglífico peculiar) associadas a outras anomalias descritas na síndrome (cardiopatia congênita e suscetibilidade aumentada para infecções). O estudo genético revelou a mutação nonsense c.14710 C > T (p.Arg4904X) no gene MLL2 nos três membros da família.Conclusões: Com a descrição de mais um caso familiar de síndrome de Kabuki, os autores pretendem ilustrar a hereditariedade autossômica dominante com expressividade variável presente nesta situação e alertar para a necessidade de uma rigorosa avaliação clínica e molecular dos familiares do afetado, permitindo um aconselhamento genético adequado.

Aims: Although there are more than 400 cases of Kabuki syndrome described in the literature, it is believed that this syndrome is under-diagnosed. Most cases occur sporadically, despite cases with autosomal dominant familial transmission being described. Here we describe three cases identified in the same family.Cases description: A family (mother and two children) was diagnosed with Kabuki syndrome. The three patients show the typical characteristics (facial appearance, musculoskeletal abnormalities, cognitive impairment, growth retardation and peculiar dermatoglyphic pattern) associated with other anomalies described in the syndrome (congenital heart disease and increased susceptibility to infections). Genetic studies revealed a nonsense mutation c.14710 C > T (p.Arg4904X) in the MLL2 gene in the three members of the family.Conclusions: With the description of another case of familial Kabuki syndrome, the authors wish to illustrate the autosomal dominant inheritance with variable expressivity, which are present in this situation, and to alert to the need for a rigorous clinical and molecular evaluation of the affected patient?s relatives, allowing appropriate genetic counseling.

A novel MLL2 gene mutation in a Korean patient with Kabuki syndrome / 소아과

Kabuki syndrome (KS) is a rare genetic disease with a distinctive dysmorphic face, intellectual disability, and multiple congenital abnormalities. KS is inherited in an autosomal dominant manner. As the primary cause of KS, MLL2 mutations have been identified in 56-76% of affected individuals who have been tested, suggesting that there may be additional genes associated with KS. Recently, a few KS individuals have been found to have de novo partial or complete deletions of an X chromosome gene, KDM6A, which encodes a histone demethylase that interacts with MLL2. Nevertheless, mutations in MLL2 are the major cause of KS. Although there are a few reports of KS patients in Korea, none of these had been confirmed by genetic analysis. Here, we report a case of a Korean patient with clinical features of KS. Using direct sequencing, we identified a frameshift heterozygous mutation for MLL2: (c.5256_5257delGA;p.Lys1753Alafs*34). Clinically, the patient presented with typical facial features, and diagnosis of KS was based on the diagnostic criteria. While KS is a rare disease, other malformations that overlap with those found in individuals with KS are common. Hence, the diagnosis of KS by mutational analysis can be a valuable method for patients with KS-like syndromes. Furthermore, in the near future, other genes could be identified in patients with KS without a detectable MLL2 mutation.

Síndrome de Kabuki: caracterización clínica, estudios genéticos, manejo preventivo de las complicaciones y asesoría genética / Kabuki syndrome: clinical, genetic, preventive management of complications and genetic counseling

Introducción: Kabuki hace referencia al teatro tradicional japonés, y el nombre del síndrome proviene de la semejanza de los pacientes al maquillaje facial usado por dichos actores. El síndrome de Kabuki es una patología dismorfológica, caracterizada por rasgos faciales particulares, entre ellos fisuras palpebrales amplias, puente nasal deprimido, cejas arqueadas con el tercio externo disperso y orejas prominentes. Todos estos rasgos son concomitantes con retraso mental, cardiopatías, nefropatías, entre otros. Debido a la presencia en mayor o menor número de veces de algunas patologías, se han dividido en anomalías menores y anomalías mayores. Objetivo: Presentar una revisión sobre las generalidades del síndrome de Kabuki, características clínicas, complicaciones y su manejo preventivo, así como los estudios genéticos realizados hasta la fecha y la asesoría genética. Metodología: se utilizaron las bases de datos Pubmed y SciELO, para la búsqueda de información. Resultados: se encontraron estudios publicados alusivos a los primeros casos del síndrome, hasta aquellos recientemente publicados en donde se identifica el gen MLL2 como etiología para este síndrome. Conclusiones: hasta la fecha, el diagnóstico se realiza por los hallazgos clínicos, aunque se puede detectar la mutación del gen MLL2. Para el diagnóstico se tienen presente los antecedentes familiares y los hallazgos al examen físico, principalmente los rasgos faciales propios de este síndrome. Complementando el diagnóstico, se debe llevar a cabo un manejo preventivo de las complicaciones para así evitar potenciales riesgos, además de ofrecer a la familia información necesaria durante la asesoría genética.

Introduction: Kabuki refers to traditional Japanese theater, and the syndrome's name comes from the similarity of the patients' facial makeup used by these actors. Kabuki syndrome is a dismorfological pathology characterized by particular facial features including wide palpebral fissures, depressed nasal tip, arched eyebrows with the lateral one-third dispersed or sparse, and prominent ears. All these features are concomitant, with mental retardation, cardiopathies, nephropathies, among others. Due to the presence in greater or lesser number of times certain pathologies, have been divided into minor and major abnormalities. Objective: present a review of the generalities of Kabuki syndrome, dismorfologicas features, clinical characteristics, complications, and genetic studies to date. Methods: we used the databases PubMed and SciELO, to search for information. Results: the published studies alluding to the first cases of the syndrome, even those published recently where MLL2 gene is identified as a possible candidate for this syndrome. Conclusions: until now the diagnosis is made by clinical findings, although it can detect the mutation of gene MLL2. For the diagnosis is given through the family history and physical examination findings, especially the facial features, characteristic of this syndrome. Complementing the diagnosis must be carry out a preventive management of complications and to avoid potential risks, and offer the family information during genetic counseling.

Isochromosome X mosaicism in a child with Kabuki syndrome phenotype: A rare cytogenetic association.

Isochromosome is a structurally unbalanced chromosome consisting of two short arms or two long arms, which are derived by abnormal centromere division or sister-chromatid exchange. Most autosomal isochromosomes are unusual, while those involving sex chromosomes are common. Kabuki syndrome (KS, OMIM 147920) is a multiple malformation/mental retardation syndrome of unknown etiology. A conventional cytogenetic study on lymphocytes from a 4-year-old girl with physical features suggestive of KS was found to have mosaicism for isochromosome for the long arm of the X. Although most manifestations present in this patient have been described before, this report is a rare association of clinical and cytogenetic findings in this syndrome. A genome-wide analysis and a larger number of patient groups studied could improve our understanding of the genetic basis of KS.

Strabismus and Poor Stereoacuity Associated with Kabuki Syndrome

Kabuki syndrome is characterized by long palpebral fissures, large ears, a depressed nasal tip, and skeletal anomalies associated with postnatal dwarfism and mental retardation. There have been few prior detailed descriptions of strabismus or stereopsis in these patients. We report a patient with Kabuki syndrome who showed small-angle strabismus and poor stereopsis. This case illustrates the need for patients with a diagnosis of Kabuki syndrome to have an ophthalmologic evaluation. Strabismus associated with Kabuki syndrome may have a small angle that can be easily overlooked.

Treatment of Velopharyngeal Insufficiency in Kabuki Syndrome: Case Report

PURPOSE: Kabuki syndrome is a multiple malformation syndrome that was first reported in Japan. It is characterized by distinctive Kabuki-like facial features, skeletal anomalies, dermatoglyphic abnormalities, short stature, and mental retardation. We report two cases of Kabuki syndrome with the surgical intervention and speech evaluation. METHODS: Both patients had velopharyngeal insufficiency and had a superior based pharyngeal flap operation. The preoperative and postoperative speech evaluations were performed by a speech language pathologist. RESULTS: In case 1, hypernasality was reduced in spontaneous speech, and the nasalance scores in syllable repetitions were reduced to be within normal ranges. In case 2, hypernasality in spontaneous speech was reduced from severe level to moderate level and the nasalance scores in syllable repetitions were also reduced to be within normal ranges. CONCLUSION: The goal of this article is to raise awareness among plastic surgeons who may encounter such patients with unique facial features. This study shows that pharyngeal flap operation can successfully correct the velopharyngeal insufficiency in Kabuki syndrome and post operative speech therapy plays a role in reinforcing surgical result.

Audiological manifestations in Kabuki (Niikawa-Kuroki) Syndrome

Objective@#To describe the audiological profile, clinical features and briefly summarize the speech and language development of a child with Kabuki syndrome (KS). KS is a rare malformation syndrome that usually presents with mental retardation and multiple congenital anomalies including ear diseases and hearing loss. @*Methods@#Design: Case report Setting: Tertiary Public University Hospital Subject: One patient@*Results@#A five-year-old female diagnosed with KS at age three presented with moderate to severe conductive hearing loss in the right ear with a drop at the high frequencies and moderate to severe conductive sloping hearing loss in the left ear. She also had fluctuating tympanometric findings. She was fit with binaural hearing aids.@*Conclusion@#Ear diseases and hearing loss should immediately be considered in patients diagnosed with KS. A comprehensive audiological and otolaryngological evaluation should also be performed when presented with a KS case.