Abstract
We report a Saudi girl who presented at birth with neonatal diabetes, duodenal atresia, and progressive cholestasis. After other gene testing was negative, the clinical diagnosis of Mitchell-Riley syndrome was ultimately considered and further genetic analysis revealed a novel missense homozygous variant in RFX6: c.983A>T (p.asp328Val). Despite intensive management, the patient died from severe Klebsiella pneumoniae sepsis at 5 months of age. This rare syndrome should be suspected in any neonate with hyperglycemia complicated by intestinal atresia and/or progressive cholestasis that could suggest biliary hypoplasia. Early recognition and diagnosis through genetic testing are essential for guiding aggressive clinical management as well as family counseling, particularly in light of the high possibility of early death in this highly complex disorder.
Highlights
We report a Saudi girl who presented at birth with neonatal diabetes, duodenal atresia, and progressive cholestasis
Mitchell-Riley syndrome (MOM # 615710) is a syndrome characterized by neonatal diabetes, pancreatic hypoplasia, intestinal atresia, and gallbladder hypoplasia or aplasia, chronic diarrhea, intrauterine growth restriction, and consanguinity
Mitchell et al reported five pediatric patients with neonatal diabetes mellitus (NDM) resulting from pancreatic hypoplasia, who presented with intestinal atresias and hypoplastic gallbladder
Summary
We report a Saudi girl who presented at birth with neonatal diabetes, duodenal atresia, and progressive cholestasis. After other gene testing was negative, the clinical diagnosis of Mitchell-Riley syndrome was considered and further genetic analysis revealed a novel missense homozygous variant in RFX6: c.983A>T (p.asp328Val).
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