Syndromic Hearing Loss in Association with PTPN11-Related Disorder: The Experience of Cochlear Implantation in a Child with LEOPARD Syndrome

Hearing loss (HL) is one of the most frequent clinical manifestations of patients who suffer with multi-systemic genetic disorders. HL in association with other physical stigmata is referred to as a syndromic form of HL. LEOPARD syndrome (LS) is one of the disorders with syndromic HL and it is caused by a mutation in the PTPN11 or RAF1 gene. In general, 5 year old children who undergo cochlear implantation usually show a marked change in behavior regarding sound detection within the first 6 months of implant use, but word identification may not be exhibited for at least another 6-12 months of implant use. We herein report on a 5-year-old girl with LS. Her clinical manifestations including bilateral sensorineural HL, which indicated the diagnosis of LS. We confirmed the diagnosis by identifying a disease-causing mutation in the PTPN11 gene, which was a heterozygous missense mutation Ala461Thr (c.1381G>A). She underwent cochlear implantation (CI) without complications and she is currently on regular follow-up at postoperative 1 year. This is the first reported case of CI in a patient with LS in the medical literature.

[1]  G. Di Salvo,et al.  Genotype–phenotype analysis and natural history of left ventricular hypertrophy in LEOPARD syndrome , 2008, American journal of medical genetics. Part A.

[2]  G. Di Salvo,et al.  Prevalence and clinical significance of cardiovascular abnormalities in patients with the LEOPARD syndrome. , 2007, The American journal of cardiology.

[3]  Michael J Ackerman,et al.  Gain-of-function RAF1 mutations cause Noonan and LEOPARD syndromes with hypertrophic cardiomyopathy , 2007, Nature Genetics.

[4]  B. Dallapiccola,et al.  A novel PTPN11 gene mutation bridges Noonan syndrome, multiple lentigines/LEOPARD syndrome and Noonan-like/multiple giant cell lesion syndrome , 2004, European Journal of Human Genetics.

[5]  M. Digilio,et al.  Clinical and molecular analysis of 30 patients with multiple lentigines LEOPARD syndrome , 2004, Journal of Medical Genetics.

[6]  M. Digilio,et al.  Grouping of multiple-lentigines/LEOPARD and Noonan syndromes on the PTPN11 gene. , 2002, American journal of human genetics.

[7]  J. Fryns,et al.  PTPN11 mutations in LEOPARD syndrome , 2002, Journal of medical genetics.

[8]  I. Temple,et al.  Multiple lentigines syndrome (LEOPARD syndrome or progressive cardiomyopathic lentiginosis). , 1997, Journal of medical genetics.

[9]  D. Evans,et al.  Neurofibromatosis/Noonan phenotype: a variable feature of type 1 neurofibromatosis , 1996, Clinical genetics.

[10]  G. Annéren,et al.  Noonan syndrome with café‐au‐lait spots and multiple lentigines syndrome are not linked to the neurofibromatosis type 1 locus , 1995, Clinical genetics.

[11]  J. Opitz,et al.  Noonan phenotype associated with neurofibromatosis. , 1985, American journal of medical genetics.

[12]  H. Seuánez,et al.  Cardio‐cutaneous syndrome (the “LEOPARD” syndrome). Review of the literature and a new family , 1976, Clinical genetics.

[13]  R. Kalkhoff,et al.  Multiple lentigines syndrome. Case report and review of the literature. , 1976, The American journal of medicine.

[14]  R. Gorlin,et al.  Multiple Lentigenes Syndrome: Complex Comprising Multiple Lentigenes, Electrocardiographic Conduction Abnormalities, Ocular Hypertelorism, Pulmonary Stenosis, Abnormalities of Genitalia, Retardation of Growth, Sensorineural Deafness, and Autosomal Dominant Hereditary Pattern , 1969 .

[15]  S. Singh,et al.  Multiple lentigenes syndrome. , 2002, Indian journal of dermatology, venereology and leprology.

[16]  S. Staller Use of the Nucleus 22 Channel Cochlear Implant System with Children. , 1994 .