The ADNP-gene-related
neurodevelopmental disorder Helsmoortel-Van der Aa syndrome is a rare syndromic-
intellectual disability-an
autism spectrum disorder first described by Helsmoortel and Van der Aa in 2014. Recently, a large cohort including 78 patients and their detailed phenotypes were presented by Van Dijck et al., 2019, who reported developmental
delay, speech delay and
autism spectrum disorder as nearly constant findings with or without variable cardiological, gastroenterological, urogenital, endocrine and
neurological manifestations. Among cardiac malformations,
atrial septal defect,
patent ductus arteriosus,
patent foramen ovale and
mitral valve prolapse were the most common findings, but other unspecified defects, such as mild
pulmonary valve stenosis, were also described. We present two patients with pathogenic ADNP variants and unusual cardiothoracic manifestations-
Bland-White-Garland syndrome,
pectus carinatum superiorly along the costochondral junctions and
pectus excavatum inferiorly in one patient, and
Kawasaki syndrome with pericardiac effusion, coronary artery dilatation and
aneurysm in the other-who were successfully treated with
intravenous immunoglobulin,
corticosteroid and
aspirin. Both patients had ectodermal and/or skeletal features overlapping those seen in RASopathies, supporting the observations of Alkhunaizi et al. 2018. on the clinical overlap between Helsmoortel-Van der Aa syndrome and
Noonan syndrome. We observed a morphological overlap with the Noonan-like disorder with anagen hair in our patients.