Article

Progressive pseudorheumatoid dysplasia misdiagnosed asankylosing spondylitis: a case report

  • Rui LIU ,
  • Jia-yu ZHAI ,
  • Xiang-yuan LIU ,
  • Zhong-qiang YAO
Expand
  • Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China

Received date: 2018-07-26

  Online published: 2018-12-18

Abstract

In this study, we reported a case of progressive pseudorheumatoid dysplasia in Peking University Third Hospital. A 56-year-old male patient presented with hip joint pain for more than 40 years and multiple joints pain with limitation of movements of these joints for 28 years. This patient suffered from joint pain and impaired range of motion of the hip, knee, elbow and shoulder gradually, associated with difficulty in walking and inability to take care of himself. He was diagnosed with “femoral head necrosis” or “ankylosing spondylitis” in local hospitals, but the treatment of nonsteroidal antiinflammatory drugs (NSAIDs) and sulfasalazine was not effective. Up to the age of 14, the patient displayed normal physical development, with the highest height was about 158 cm, according to the patient recall. However, his height was 153 cm at present. There was no history of similar illness in any family member. Physical examinations descried limitation of movement of almost all joints. Enlargement and flexion deformity of the proximal interphalangeal (PIP) joints of the hands resulted in the claw hand appearance. Limited abduction and internal and external rotation of the shoulder and hip could be find. He had normal laboratory findings for blood routine test, biochemical indexes and acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Furthermore, HLA-B27 and autoimmune antibodies such as rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) antibody and antinuclear antibody (ANA) were all negative. X-ray of the hip showed loss of the joint space and irregularities of the femoral head, both femoral head were flattened, it could be see hyperplasia, osteophytes, bilateral femoral neck thicken, neck dry angle turned smaller. The radiological findings of the spinal vertebra indicated kyphosis deformity, narrowing of the intervertebral discs, vertebral syndesmophytes and flattening of the vertebra. However, there was no clues of bone marrow edema in the lumbar MRI. At last, genetic testing for the Wnt1-inducible signaling pathway protein 3 (WISP3) gene was done and indicated compound heterozygous mutations: 756C>G and c.866dupA. These two mutations were derived from the patient’s mother and father (the patient’s parents each had a heterozygous mutation). Two exons of the WISP3 gene had nucleotide changes leading to amino acid mutations. According to the patient’s history, symptoms, physical examinations, radiological findings and genetic testing, the final definitive diagnosis was progressive pseudorheumatic dysplasia.

Cite this article

Rui LIU , Jia-yu ZHAI , Xiang-yuan LIU , Zhong-qiang YAO . Progressive pseudorheumatoid dysplasia misdiagnosed asankylosing spondylitis: a case report[J]. Journal of Peking University(Health Sciences), 2018 , 50(6) : 1112 -1116 . DOI: 10.19723/j.issn.1671-167X.2018.06.031

References

[1] 邓小虎, 黄烽, 张江林 , 等. 进行性假性类风湿发育不良症的临床分析[J]. 解放军医学杂志, 2006,31(4):351-353.
[2] 叶军, 张惠文, 王彤 , 等. 进行性假性类风湿性发育不良症的临床诊断及WISP3基因突变分析[J]. 中华儿科杂志, 2010,48(3):194-198.
[3] Wynne-Davies R, Hall C, Ansell BM . Spondylo-epiphysial dysplasia tarda with progressive arthropathy. A “new” disorder of autosomal recessive inheritance[J]. J Bone Joint Surg Br, 1982,64(4):442-445.
[4] Hurvitz JR, Suwairi WM, Van Hul W , et al. Mutations in the CCN gene family member WISP3 cause progressive pseudorheu-matoid dysplasia[J]. Nat Genet, 1999,23(1):94-98.
[5] Delague V, Chouery E, Corbani S , et al. Molecular study of WISP3 in nine families originating from the Middle-East and presenting with progressive pseudorheumatoid dysplasia: identification of two novel mutations, description of a founder effect [J]. Am J Med Genet, 2005, 138 A( 2):118-126.
[6] Bennani L, Amine B, Ichchou L , et al. Progressive pseudorheumatoid dysplasia: three cases in one family[J]. Joint Bone Spine, 2007,74(4):393-395.
[7] Yue H, Zhang ZL, He JW . Identification of novel mutations in WISP3 gene in two unrelated Chinese families with progressive pseudorheumatoid dysplasia[J]. Bone, 2009,44(4):547-554.
[8] Sailani MR, Chappell J, Jingga I , et al. WISP3 mutation associated with pseudorheumatoid dysplasia[J]. Cold Spring Harb Mol Case Stud, 2018,4(1):1-11.
[9] Hu Q, Liu J, Wang Y , et al. Delayed-onset of progressive pseudo-rheumatoid dysplasia in a Chinese adult with a novel compound WISP3 mutation: a case report[J]. BMC Medical Genetics, 2017,18(1):149.
[10] Ye J, Zhang HW, Qiu WJ , et al. Patients with progressive pseudo-rheumatoid dysplasia: from clinical diagnosis to molecular studies[J]. Mol Med Rep, 2012,5(1):190-195.
[11] Zhou HD, Bu YH, Peng YQ , et al. Cellular and molecular responses in progressive pseudorheumatoid dysplasia articular cartilage associated with compound heterozygous WISP3 gene mutation[J]. J Mol Med (Berl), 2007,85(9):985-996.
[12] Sun J, Xia W, He S , et al. Novel and recurrent mutations of WISP3 in two Chinese families with progressive pseudorheumatoid dysplasia[J]. PLoS One. 2012,7(6):e38643.
[13] Yu Y, Hu M, Xing X , et al. Identification of a mutation in the WISP3 gene in three unrelated families with progressive pseudorheumatoid dysplasia[J]. Mol Med Rep, 2015,12(1):419-425.
[14] Liu L, Li N, Zhao Z , et al. Novel WISP3 mutations causing spondyloepiphyseal dysplasia tarda with progressive arthropathy in two unrelated Chinese families[J]. Joint Bone Spine, 2015,82(2):125-128.
[15] Yan W, Dai J, Xu Z , et al. Novel WISP3 mutations causing progressive pseudorheumatoid dysplasia in two Chinese families[J]. Hum Genome Var, 2016(3):16041.
[16] Luo H, Shi C, Mao C , et al. A novel compound WISP3 mutation in a Chinese family with progressive pseudorheumatoid dysplasia[J]. Gene, 2015,564(1):35-38.
[17] EI-Shant HE, Omari HZ, Qubain HL . Progressive pseudorheumatoid dysplasia:report of a family and review[J]. J Med Genet, 1997,34(7):559-563.
[18] 曹春霞, 郭雄, 张永忠 . 青少年大骨节病诊断指标筛选和模型的构建[J]. 中国地方病学杂志, 2011,30(6):687-690.
[19] 史晓薇, 郭雄 . COL9A1基因多态性与儿童大骨节病的关联分析[J]. 中国妇幼健康研究, 2016,27(5):556-557, 646.
[20] 马民, 刘红光, 王其军 . 大骨节病的X线及CT诊断[J]. 实用医学影像杂志, 2003,4(2):83-85
[21] 钱向东, 赵云辉 . 非病区成人大骨节病的X线诊断及鉴别诊断[J]. 新疆医学, 2013,43(7):110-113.
Outlines

/