Physical Development and Puberty in Related Patients with Kindler Epidermolysis Bullosa: Case Study

Abstract

Background. Kindler epidermolysis bullosa is orphan, autosomal recessive disease and it is one of the variants of congenital epidermolysis bullosa. Its severe course is characterized by high risk of multifactorial malnutrition, chronic inflammation due to recurrent secondary skin infections, and also bone metabolism disorders, what can lead to disorders in physical development and puberty in children. However, the effect of Kindler epidermolysis bullosa on patients’ physical development and puberty remains unexplored. Clinical case description. Family case of Kindler epidermolysis bullosa was presented in 13 and 12 years old patients, third degree of kinship (maternal, uncle — nephew) with typical clinical manifestations for this disease. The diagnosis was confirmed in both patients via Sanger sequencing and revealing identical pathogenic variants in the FERMT1 gene (two deletions in the compound-heterozygous state — c.778del, p.Q260Kfs*21 and c.1088del, p. L363Wfs*39). Reduced concentrations of testosterone and 25(OH)D were revealed, whereas, increased concentration of adrenocorticotropic hormone — only in the older patient. The concentrations of luteinizing hormone, follicle-stimulating hormone and estradiol in both patients were within the reference values. The younger patient had prepubertal sizes and volume of testicles. Both patients had specific features of psychoemotional state: mood swing with rapid increase in anxiety level in the older patient and difficulties in emotional-volitional regulation in younger one. Conclusion. Patients with Kindler epidermolysis bullosa have high risk of physical development and puberty delay due to its systemic chronic pathological process. Thus, these patients require dynamic follow-up by pediatrician and pediatric endocrinologist.