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Proteus Syndrome: Case Report and Updated Literature Review

  • Maria K Klimeczek-Chrapusta (Malopolska Burn and Plastic Surgery Center, Ludwik Rydygier Memorial Hospital in Krakow) ;
  • Marek Kachnic (Student Scientific Group of Pediatric Surgery, Department of Pediatric Surgery, Jagiellonian University Medical College, Faculty of Medicine) ;
  • Anna Chrapusta (Malopolska Burn and Plastic Surgery Center, Ludwik Rydygier Memorial Hospital in Krakow)
  • Received : 2023.10.18
  • Accepted : 2024.04.03
  • Published : 2024.07.15

Abstract

Proteus syndrome (PS) is an exceptionally uncommon genetic disorder that has been documented in only approximately 250 cases in the literature spanning the past four decades. It is characterized by a disproportionate, asymmetric overgrowth of all types of tissues, provoked by a somatic activating mutation in serine/threonine protein kinase 1. We report a case of PS in a two-year-old female patient with the following clinical features: unilateral overgrowth of connective tissue in the right buttock and right foot, where multiple surgeries were performed to achieve a desirable aesthetic outcome and ensure psychological comfort of the young patient. The insights provided by this case underscore the pivotal role of obtaining pleasing aesthetic outcomes in the surgical management of untreatable genetic disorders, with the aim of nurturing psychological contentment in affected children.

Keywords

References

  1. Cohen MM Jr. Proteus syndrome review: molecular, clinical, and pathologic features. Clin Genet 2014;85(02):111-119 
  2. Lindhurst MJ, Sapp JC, Teer JK, et al. A mosaic activating mutation in AKT1 associated with the Proteus syndrome. N Engl J Med 2011;365(07):611-619 
  3. Cohen MM Jr, Hayden PW. A newly recognized hamartomatous syndrome. Birth Defects Orig Artic Ser 1979;15(5B):291-296 
  4. Amer N, Al Helal J, Al Hajji M, et al. Proteus syndrome, a rare case with an unusual presentation: case report. Int J Surg Case Rep 2020;72:339-342 
  5. Munhoz L, Arita ES, Nishimura DA, Watanabe PCA. Maxillofacial manifestations of Proteus syndrome: a systematic review with a case report. Oral Radiol 2021;37(01):2-12 
  6. Furquim I, Honjo R, Bae R, et al. Proteus syndrome: report of a case with recurrent abdominal lipomatosis. J Pediatr Surg 2009;44(04):E1-E3 
  7. Ou M, Sun Z, Zhu P, Sun G, Dai Y. Proteus syndrome: a case report and review of the literature. Mol Clin Oncol 2017;6(03):381-383 
  8. Buser A, Lindhurst MJ, Kondolf HC, et al. Allelic heterogeneity of Proteus syndrome. Cold Spring Harb Mol Case Stud 2020;6(03):a005181 
  9. Duarte Santos C, Lizardo Gracio R, Costa Pires T, et al. Proteus syndrome: a rare case in an adult ward. Eur J Case Rep Intern Med 2021;8(04):002554 
  10. Rocha RCC, Estrella MPS, Amaral DMD, Barbosa AM, Abreu MAMM. Proteus syndrome. . An Bras Dermatol 2017;92(05):717-720 
  11. Weibel L, Theiler M, Gnannt R, et al. Reduction of disease burden with early sirolimus treatment in a child with Proteus syndrome. JAMA Dermatol 2021;157(12):1514-1516 
  12. Ours CA, Sapp JC, Hodges MB, de Moya AJ, Biesecker LG. Case report: five-year experience of AKT inhibition with miransertib (MK-7075) in an individual with Proteus syndrome. Cold Spring Harb Mol Case Stud 2021;7(06):a006134 
  13. Leoni C, Gullo G, Resta N, et al. First evidence of a therapeutic effect of miransertib in a teenager with Proteus syndrome and ovarian carcinoma. Am J Med Genet A 2019;179(07):1319-1324 
  14. Lindhurst MJ, Yourick MR, Yu Y, Savage RE, Ferrari D, Biesecker LG. Repression of AKT signaling by ARQ 092 in cells and tissues from patients with Proteus syndrome. Sci Rep 2015;5:17162 
  15. Crenshaw MM, Goerlich CG, Ivey LE, et al. Orthopaedic management of leg-length discrepancy in Proteus syndrome: a case series. J Pediatr Orthop 2018;38(03):e138-e144 
  16. Modlin EW, Slavotinek AM, Darling TN, et al. Late-onset Proteus syndrome with cerebriform connective tissue nevus and subsequent development of intraductal papilloma. Am J Med Genet A 2022;188(09):2766-2771 
  17. Keppler-Noreuil KM, Sapp JC, Lindhurst MJ, et al. Pharmacodynamic study of miransertib in individuals with Proteus syndrome. Am J Hum Genet 2019;104(03):484-491 
  18. Popescu MD, Burnei G, Draghici L, Draghici I. Proteus syndrome: a difficult diagnosis and management plan. J Med Life 2014;7(04):563-566 
  19. He M, Zhao W. Proteus syndrome of the foot: a case report and literature review. Exp Ther Med 2020;20(03):2716-2720 
  20. Biesecker LG, Happle R, Mulliken JB, et al. Proteus syndrome: diagnostic criteria, differential diagnosis, and patient evaluation. Am J Med Genet 1999;84(05):389-395 
  21. Biesecker L. The challenges of Proteus syndrome: diagnosis and management. Eur J Hum Genet 2006;14(11):1151-1157 
  22. Zhou X, Hampel H, Thiele H, et al. Association of germline mutation in the PTEN tumour suppressor gene and Proteus and Proteus-like syndromes. Lancet 2001;358(9277):210-211 
  23. Cohen MM Jr, Turner JT, Biesecker LG. Proteus syndrome: misdiagnosis with PTEN mutations. Am J Med Genet A 2003;122A(04):323-324 
  24. Sapp JC, Buser A, Burton-Akright J, Keppler-Noreuil KM, Biesecker LG. A dyadic genotype-phenotype approach to diagnostic criteria for Proteus syndrome. Am J Med Genet C Semin Med Genet 2019;181(04):565-570 
  25. Biesecker LG, Sapp JC. Proteus syndrome. In: Adam MP, Mirzaa GM, Pagon RA, et al, eds. GeneReviews®. Seattle (WA):: University of Washington; 1993-2023. 2012. Updated May 25, 2023. 
  26. Sapp JC, Turner JT, van de Kamp JM, van Dijk FS, Lowry RB, Biesecker LG. Newly delineated syndrome of congenital lipomatous overgrowth, vascular malformations, and epidermal nevi (CLOVE syndrome) in seven patients. Am J Med Genet A 2007;143A(24):2944-2958 
  27. Robert J, Marchand A, Mazereeuw-Hautier J, et al; Groupe de Recherche de la Societe Francaise de Dermatologie Pediatrique. Quality of life of children with capillary malformations of the lower limbs: Evolution and associated factors. Data from the French national paediatric cohort, CONAPE. Ann Dermatol Venereol 2022;149(04):271-275 
  28. Harvey JA, Nguyen H, Anderson KR, et al. Pain, psychiatric comorbidities, and psychosocial stressors associated with Klippel-Trenaunay syndrome. J Am Acad Dermatol 2018;79(05):899-903