Genetic mutation in Hirschsprungs/congenital central hypoventilation syndrome

Abstract

Background: Congenital central hypoventilation syndrome (CCHS) is a disorder of respiratory and autonomic regulation which presents with hypoventilation. In some patients, CCHS is associated with Hirschsprung disease and as such known as Haddad syndrome. Case presentation: A preterm was referred to our intensive care unit due to suspicion of meconium ileus after loop-ileostomy at the age of 8 days. The patient presented with recurrent apnea, did not respond to caffeine citrate, and was dependent on ventilation. Furthermore, the patient was unable to pass stool spontaneously. In the course of clinical deterioration, fluoroscopy showed a perforation next to the ileostomy and resection of ileum was conducted. An ileostomy was performed, and several biopsies of the intestines were taken. Neither in the biopsies nor in the resected segment were ganglion cells identified histopathologically. Considering the poor prognosis, life support was withdrawn. Autopsy and histology verified total aganglionosis of the intestines. Genetic testing confirmed a rare pathogenic deletion in the alanine-repeat region in the PHOX2B (c.722-759del; p.Ala241Glyfs*106). Conclusion: CCHS and intestinal aganglionosis are hints for Haddad syndrome. To confirm the diagnosis, biopsies of the intestines and genetic testing for mutations in the PHOX2B gene should be performed.

Keywords

• Case report
• Haddad syndrome
• Preterm infant
• CCHS
• Hirschsprung disease