ABSTRACT
Meckel Gruber es un síndrome letal poco común, descrito por primera vez en 1822 por Meckel; se caracteriza por múltiples malformaciones congénitas que afectan principalmente la cabeza, riñones, dedos de manos y pies. De herencia autosómica recesiva, es reportado comúnmente en matrimonios consanguíneos, también ocurre en las parejas no consanguíneas. Ha sido descrito en todo el mundo, y su incidencia oscila entre 1 por 13 250 - 140 000 nacidos vivos. Comúnmente se diagnostica desde la semana 18 mediante ecografía, aunque se puede hacerlo más tempranamente en familias de alto riesgo. Se reporta el caso clínico de una paciente atendida en el Hospital Obrero No 2 de la Caja Nacional de Salud, sin antecedente de consanguinidad con su pareja, tuvo tres embarazos, de los cuales dos tenían el síndrome de Meckel-Gruber.
Meckel-Gruber is an uncommon lethal syndrome, it was described by Meckel in 1822 characterized by multiple congenital malformations, that mainly affects the head, kidneys and fingers; is a autosomal recessive inheritance, reported in consanguineous marriages, but also in non-consanguineous marriages. The worldwide incidence varies from in 13 250 to 140 000 live births. It is usually diagnosed from 18 weeks of pregnancy by ultrasound, although it can be done earlier in high-risk families. We reported the clinical case of a patient treated in Hospital Obrero No 2 de la Caja Nacional de Salud without a history of consanguinity with her partner with whom she had three pregnancies, of wich two had Meckel-Gruber syndrome.
Subject(s)
Humans , Female , Pregnancy , Adult , Congenital Abnormalities , Heredity/genetics , Genetic HeterogeneityABSTRACT
En el Hospital José María Velasco Ibarra de la ciudad del Tena, provincia de Napo, en la República de Ecuador, se reportó el caso de un neonato con Síndrome de Meckel Gruber, de sexo femenino, fruto de un embarazo sin seguimiento prenatal, hijo de padres indígenas no consanguíneos, provenientes de la comunidad amazónica Tamiahurco ubicada en Misahuallí. En este recién nacido se presentó la triada diagnóstica al respecto: riñones hiperplásicos poliquísticos, encefalocele occipital y polidactilia postaxial bilateral, determina el diagnóstico de certeza de esta enfermedad, en la que al menos dos de estos elementos deben estar presentes. Además, puede cursar con malformaciones a nivel oral, genital, del Sistema Nervioso Central (SNC) y fibrosis hepática(AU)
At José María Velasco Ibarra Hospital in Tena, Napo province, in the Republic of Ecuador, the case of a female neonate with Meckel Gruber Syndrome is reported. This infant is the result of a pregnancy with no prenatal follow-up, non-consanguineous indigenous parents, from the Tamiahurco Amazon community, in Misahuallí. This newborn had the diagnostic triad of polycystic hyperplastic kidneys, occipital encephalocele and bilateral postaxial polydactyly, which determined this disease diagnosis of certainty, in which at least two of these elements must be present. Other symptoms are oral, genital malformations, hepatic fibrosis and malformations of the Central Nervous System (CNS)(AU)
Subject(s)
Humans , Female , Infant, Newborn , Health of Indigenous Peoples , Ciliopathies/mortality , Prenatal Care/methods , Follow-Up StudiesABSTRACT
En el Hospital José María Velasco Ibarra de la ciudad del Tena, provincia de Napo, en la República de Ecuador, se reportó el caso de un neonato con Síndrome de Meckel Gruber, de sexo femenino, fruto de un embarazo sin seguimiento prenatal, hijo de padres indígenas no consanguíneos, provenientes de la comunidad amazónica Tamiahurco ubicada en Misahuallí. En este recién nacido se presentó la triada diagnóstica al respecto: riñones hiperplásicos poliquísticos, encefalocele occipital y polidactilia postaxial bilateral, determina el diagnóstico de certeza de esta enfermedad, en la que al menos dos de estos elementos deben estar presentes. Además, puede cursar con malformaciones a nivel oral, genital, del Sistema Nervioso Central (SNC) y fibrosis hepática(AU)
At José María Velasco Ibarra Hospital in Tena, Napo province, in the Republic of Ecuador, the case of a female neonate with Meckel Gruber Syndrome is reported. This infant is the result of a pregnancy with no prenatal follow-up, non-consanguineous indigenous parents, from the Tamiahurco Amazon community, in Misahuallí. This newborn had the diagnostic triad of polycystic hyperplastic kidneys, occipital encephalocele and bilateral postaxial polydactyly, which determined this disease diagnosis of certainty, in which at least two of these elements must be present. Other symptoms are oral, genital malformations, hepatic fibrosis and malformations of the Central Nervous System (CNS)(AU)
Subject(s)
Humans , Female , Infant, Newborn , Health of Indigenous Peoples , Ciliopathies/mortality , Prenatal Care/methods , Follow-Up StudiesABSTRACT
Os autores relatam um caso de diagnóstico pré-natal de síndrome de Meckel-Gruber em gestante de 12 anos de idade. A primeira ultra-sonografia, realizada na 32ª semana, identificou feto único portador de microcefalia, volumosa encefalocele na linha média da região occipital, lábio leporino completo bilateral e fenda palatina. Os rins encontravam-se de dimensões e ecotextura aumentadas, medindo cerca de 12 cm de comprimento, levando a importante aumento do volume abdominal. A genitália fetal não foi identificada, sendo visualizada pequena imagem cística na sua topografia.Em função da presença de oligodramnia, foi realizada ressonância magnética na 33ª semana, que confirmou os achados ultra-sonográficos e demonstrou uma lisencefalia. Na 34ª semana, a gestação evoluiu com amniorrexe prematura, sendo realizada cesariana, com retirada de natimorto, posteriormente encaminhado à necropsia. Polidactilia foi a única alteração presente não-identificada pelos métodos de imagem.
The authors report a case of antenatal ultrasound diagnosis of Meckel-Gruber syndrome in a 12-year-old pregnant girl. The first scan done at 32 weeks of gestation revealed a single fetus withmicrocephaly, large encephalocele in the occipital mid-line region, bilateral complete cleft lip, and cleft palate. The kidneys and their ecotexture were found to be enlarged, measuring about 12 cm in length, causing an important enlargement of the abdomen. The fetus' genitals were not identified, but a small cystic image was visualized in their topography. Due to the presence of oligohydramnios, a magnetic resonance was performed at 33 weeks of gestation,which confirmed the sonographic findings and demonstrated a lisencephaly. A premature rupture of membranes occurred at 34 weeks of gestation, upon which a caeserian section was performed, the stillborn baby removed and subsequently taken for a necropsy. Polydactyly was the only anomaly present which was not identified by the imaging methods used.
