A SPECTRUM OF PHENOTYPICAL EXPRESSION OF NEU-LAXOVA SYNDROME: Three Case Reports and a Review of the Literature

Wendy L. Coto-Pucketta, Enid Gilbert-Barnessb, Charlotte K. Steelmanc, Tami Stuartd, Haynes B. Robinsone & Bahig M. Shehatad*a Department of Neonatology, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgiab Departments of Pathology, Pediatrics, and Obstetrics and Gynecology, University of South Florida and Tampa General Hospital, Tampa, Floridac Department of Pediatric Pathology, Children's Healthcare of Atlanta, Atlanta, Georgiad Department of Pediatric Pathology, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgiae Departments of Pathology and Genetics, Akron Children's Hospital, Akron, OhioAddress correspondence to Bahig Shehata, Department of Pediatric Pathology, 1405 Clifton Road, Atlanta, GA 30322. E-mail: bshehat@emory.eduNeu-Laxova syndrome is a rare autosomal recessive disorder characterized by severe intra-uterine growth restriction, extreme microcephaly, marked edema with skin restriction, ichthyosis, craniofacial anomalies, limb deformities, and a spectrum of central nervous system malformations. Less than 70 cases have been described since the first report in 1971. To this day the etiology and genetic basis remains unknown. Consanguinity has been reported. Some authors have postulated the syndrome to be a form of neuro-ectodermal dysplasia, while others suggest that it is a malformation syndrome secondary to severe skin restriction. Although the outcome of this syndrome is lethal, a single case of longer survival (6 months) has been reported. The majority of cases are stillborn or die shortly after birth. Thus, it is clear that Neu-Laxova exhibits a spectrum of disease, with varying degrees of phenotypic expression. We are presenting three new cases of Neu-Laxova syndrome; two were stillbirths and one lived for eleven weeks. Our microscopic and post-mortem findings in these three cases display the vast spectrum of this rare syndrome