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2012 ; 1
(2
): 125-9
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RASA1 analysis guides management in a family with capillary
malformation-arteriovenous malformation
#MMPMID27625812
Flore LA
; Leon E
; Maher TA
; Milunsky JM
J Pediatr Genet
2012[Jun]; 1
(2
): 125-9
PMID27625812
show ga
Capillary malformation-arteriovenous malformation (CM-AVM; MIM 60354) is an
autosomal dominant disorder characterized by multifocal cutaneous capillary
malformations, often in association with fast-flow vascular lesions, which may be
cutaneous, subcutaneous, intramuscular, intraosseus, or cerebral arteriovenous
malformations or arteriovenous fistulas. CM-AVM results from heterozygous
mutations in the RASA1 gene. Capillary malformations of the skin are common, and
clinical examination alone may not be able to definitively diagnose-or exclude-
CM-AVM. We report a family in which the proband was initially referred for a
genetic evaluation in the neonatal period because of the presence of a cardiac
murmur and minor dysmorphic features. Both he and his mother were noted to have
multiple capillary malformations on the face, head, and extremities.
Echocardiography revealed dilated head and neck vessels and magnetic resonance
imaging and angiography of the brain revealed a large infratentorial
arteriovenous fistula, for which he has had two embolization procedures. RASA1
sequence analysis revealed a heterozygous mutation, confirming his diagnosis of
CM-AVM. We established targeted mutation analysis for the proband's mother and
sister, the latter of whom is a healthy 3-year-old whose only cutaneous finding
is a facial capillary malformation. This revealed that the proband's mother is
also heterozygous for the RASA1 mutation, but his sister is negative.
Consequently, his mother will undergo magnetic resonance imaging and angiography
screening for intracranial and spinal fast-flow lesions, while his sister will
require no imaging or serial evaluations. Targeted mutation analysis has been
offered to additional maternal family members. This case illustrates the benefit
of molecular testing in diagnosis and making screening recommendations for
families with CM-AVM.