Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2020; 8(23): 5962-5975
Published online Dec 6, 2020. doi: 10.12998/wjcc.v8.i23.5962
Genetic diagnosis history and osteoarticular phenotype of a non-transfusion secondary hemochromatosis
Dan-Dan Ruan, Yu-Mian Gan, Tao Lu, Xiao Yang, Yao-Bin Zhu, Qing-Hua Yu, Li-Sheng Liao, Ning Lin, Xin Qian, Jie-Wei Luo, Fa-Qiang Tang
Dan-Dan Ruan, Yu-Mian Gan, Tao Lu, Qing-Hua Yu, Li-Sheng Liao, Ning Lin, Xin Qian, Jie-Wei Luo, Fa-Qiang Tang, Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China
Xiao Yang, Department of Management, Fujian Health College, Fuzhou 350101, Fujian Province, China
Yao-Bin Zhu, Department of Traditional Chinese Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, Fujian Province, China
Fa-Qiang Tang, Department of Orthopedics, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
Author contributions: Ruan DD, Gan YM, Lu T, Yang X and Zhu YB performed the acquisition, analysis, and interpretation of the clinical data; Ruan DD, Zhu YB and Luo JW drafted the manuscript; Liao LS, Lin N and Yu QH provided critical revision of the manuscript; Luo JW and Qian X designed and supervised the study.
Supported by National Natural Science Foundation of China, No. 81874379; Fujian Province Medical Innovation Foundation, No. 2019-CXB-3 and 2019-CXB-4.
Institutional review board statement: This study was approved by the Ethics Committee of Fujian Provincial Hospital (Fuzhou, China).
Informed consent statement: The patient provided written informed consent prior to study enrollment.
Conflict-of-interest statement: The authors do not have any conflict of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fa-Qiang Tang, MD, Chief Physician, Doctor, Shengli Clinical Medical College, Fujian Medical University, No. 134 Dongjie, Fuzhou 350001, Fujian Province, China. faqiangtang@fjmu.edu.cn
Received: April 11, 2020
Peer-review started: April 11, 2020
First decision: May 26, 2020
Revised: July 23, 2020
Accepted: October 12, 2020
Article in press: October 12, 2020
Published online: December 6, 2020
Processing time: 232 Days and 19.6 Hours
Abstract
BACKGROUND

It is not easy to identify the cause of various iron overload diseases because the phenotypes overlap. Therefore, it is important to perform genetic testing to determine the genetic background of patients.

AIM

To investigate the genetic background of a patient with hemochromatosis complicated by psoriasis on both lower extremities.

METHODS

Ten years ago, a 61-year-old male presented with iron overload, jaundice, hemolytic anemia and microcytic hypochromic anemia. Computed tomography of the left knee joint showed enlargement of the tibial medullary cavity and thinned bone cortices. Magnetic resonance imaging showed hepatic hemochromatosis, extensive abnormal signals from bone marrow cavities and nodular lesions in the lateral medullary cavity of the upper left lateral tibia. Single photon emission computed tomography showed radial dots of abnormal concentration in the upper end of the left tibia and radial symmetry of abnormal concentrations in joints of the extremities. The patient showed several hot spot mutations of the HFE and G6PD genes detected by next-generation sequencing, but no responsible gene mutation was found. The thalassemia gene was detected by gap-PCR.

RESULTS

The patient was found to carry the -α4.2 and --SEA deletion mutations of the globin gene. These two mutations are common causes of Southeast Asian α-thalassemia, but rarely cause severe widespread non-transfusion secondary hemochromatosis osteoarthropathy. The simultaneous presence of an auxiliary superposition effect of a rare missense mutation of the PIEZO1 gene (NM_001142864, c.C4748T, p.A1583V) was considered. Moreover, several rare mutations of the IFIH1, KRT8, POFUT1, FLG, KRT2, and TGM5 genes may be involved in the pathogenesis of psoriasis.

CONCLUSION

The selection of genetic detection methods for hemochromatosis still needs to be based on an in-depth study of the clinical manifestations of the disease.

Keywords: Hemochromatosis; Hemochromatosis osteoarthropathy; Next-generation sequencing; Thalassemia; Gap-PCR; PIEZO1 gene

Core Tip: Hemochromatosis (HC) is divided into two major classes: Primary and secondary. Iron overload in the patient’s body causes iron deposition in various tissues and organs, which leads to functional or structural changes. It is not easy to identify the cause of various iron overload diseases because the phenotypes overlap. Therefore, it is particularly important to use genetic tests to determine the genetic background of patients. It took us 10 years to diagnose HC using different genetic testing methods in a 61-year-old male who presented with pain and swelling in the left knee joint, jaundice, hemolytic anemia, microcytic hypochromic anemia, iron overload, hypolipidemia and normal blood glucose. The patient was primarily diagnosed with hematological disease or bone metastases. The selection of genetic detection methods for HC still needs to be based on an in-depth study of the clinical manifestations of the disease.