Paraneoplastic pemphigus: a case of long-term survival associated with systemic lupus erythematosus and polymyositis.

A 35-year-old man presented with a generalized bullous eruption and oral ulceration. He had been diagnosed as having systemic lupus erythematosus and pelvic Castleman disease (hyaline-vascular type) in the past. Histologic, direct and indirect immunofluorescence and immunoprecipitation studies confirmed a diagnosis of paraneoplastic pemphigus (PNP). Initially several medical treatments were tried unsuccessfully. The pelvic tumor was surgically removed and the mucocutaneous lesions slowly regressed. Four years after presentation, he developed polymyositis which was completely controlled with short courses of corticosteroids. There was no evidence of relapse of PNP or lupus erythematosus at that time. At the 6-year follow-up he showed no clinical evidence of PNP, lupus erythematosus or polymyositis without requiring immunosuppressive therapy. This case emphasizes the fact that patients with benign-neoplasm-associated PNP may undergo complete remission of the autoimmune disease upon complete excision of the tumor. This case also stresses the possible association of PNP with other autoimmune diseases such as lupus erythematosus and polymyositis.

Gangliosidosis GM2 tipo 2: enfermedad de Sandhoff / Gangliosidosis GM2 type 2: Sandhoff's disease

Se estudió a un niño de 19 meses de edad con un cuadro clínico sugestivo de gangliosidosis GM2: facies peculiar, retardo psicomotor severo, espasticidad generalizada, crisis convulsivas tónicas, macrocefalia, pérdida de la función visual y auditiva, reflejos osteotendinosos exaltados y primer dedo de ambos pies en flexión sostenida; manchas rojo cereza en fondo de ojo y atrofia cerebral demostrada por EEG y TAC. Mediante cromatografía de capa fina se identificaron oligosacáridos en diferentes muestras de orina con un patrón cromatográfico característico. La actividad de las hexosaminidasas A y B en el paciente y sus padre fueron compatibles con homocigocidad y heterocigocidad respectivamente, para la deficiencia de ambas enzimas. Estos resultados permitieron precisar el diagnóstico de gangliosidosis GM2 tipo 2 (Enfermedad de Sandhoff). Se señala la importancia de la identificación de la oligosacariduria

On telomere replication and fusion in eukaryotes: apropos of a case of 45,X/46,X,ter rea(X;X)(p22.3;p22.3).

A Mexican 181/2-year-old girl with short stature, primary amenorrhea, and mild Turner stigmata was found to have a 45,X/46,X,ter rea(X;X)(p22.3;p22.3) karyotype in her lymphocytes. The rearranged chromosome was twice the size of a normal X, appeared to be attached head-to-head, had no detectable chromatin loss, only one primary constriction, constitutive heterochromatin at both the centromere and pseudocentromere regions, was mitotically stable, and always showed late replication. From the analysis of this and other X;X terminal rearrangements we draw four conclusions: (1) Terminal rearrangements may arise either by telomeric fusion (tel fus) without loss of genetic material or from a conventional telomeric translocation. (2) Telomeric fusions between homologous chromosomes (the commonest type) can be secondary to impaired telomeric replication. (3) Phenotypically, patients with an X;X terminal rearrangement show great variability which depends mainly on whether or not chromatin has been lost in the rejoining process and a 45,X clone. (4) Patients with an X;X telomeric fusion without mosaicism are likely to have an XXX phenotype, whereas turneroid features are expected in mixoploidies that include an X monosomic clone and in cases of translocations involving the short arms.

Partial trisomy 1q and monosomy 18q due to a de novo t(1;18)(q25;q23).

A two-year-old girl trisomic for the segment 1q25 leads to qter and partially monosomic for band 18q23 as a consequence of a de novo t(1;18)(q25;q23) is reported. Most of the proposita's clinical findings have been described in the 1qter trisomy and some others in the 18q monosomy. This observation is interpreted as additional evidence of epi-, iso-, and hypostatic interactions at the chromosomal level.