Unveiling the Complexity: Mosaic Cardiofaciocutaneous Syndrome Presenting with Exuberant Elephantiasis Nostras Verrucosa

Authors

  • Ana Sofia Rodrigues Department of Pediatrics, Unidade Local de Saúde do Médio Ave
  • Maria de Abreu Nunes da Silva Department of Medical Genetics, Unidade Local de Saúde de Santo António
  • Aida Azevedo Department of Pediatrics, Unidade Local de Saúde do Médio Ave
  • Sónia Cristina Dias Carvalho Department of Pediatrics, Unidade Local de Saúde do Médio Ave
  • Álvaro Rui Miranda Sousa Department of Pediatrics, Unidade Local de Saúde do Médio Ave
  • Ana Fortuna Department of Medical Genetics, Unidade Local de Saúde de Santo António

DOI:

https://doi.org/10.25753/BirthGrowthMJ.v34.i3.29304

Keywords:

cardiofaciocutaneous syndrome, dysmorphic syndromes, hemihypertrophy, lymphedema, rasopathies

Abstract

Cardiofaciocutaneous syndrome (CFC) is a rare disorder of the RAS MAPK-pathway and is characterized by dysmorphic facial appearance, hair and skin abnormalities, congenital heart defects, growth retardation and global developmental delay. We report the clinical case of a 17 -year-old female with hemihypertrophy, lymphedema, dysmorphic features and intellectual disability in whom peripheral blood panel study for RASopathies confirmed the presence of KRAS pathogenic variant c.34G>A (G12D). The ectodermal phenotype, including lymphedema appeared to be restricted to the right hemihypertrophy, and its pattern is suggestive of mosaicism for the condition, which has not previously been described in CFC, to our knowledge.

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References

Magoulas PL, Fagan S, Rauen KA. Cardiofaciocutaneous syndrome. National Organization for Rare Disorders [Internet]. 2017 Jun [cited 2025 Jun 26]. Available from: https://rarediseases.org/rare-diseases/cardiofaciocutaneous-syndrome.

Seth S, Biswas T, Biswas B, Roy A, Datta AK. Cardiofaciocutaneous syndrome: case report of a rare disorder. J Clin Diagn Res. 2016;10(11):SD01–2. doi:10.7860/JCDR/2016/21586.8811.

Modi R, Patil P, Kothiwale V, Kamate M. Cardiofaciocutaneous syndrome. J Sci Soc. 2014;41:195–6. doi:10.4103/0974-5009.141231.~

Orphanet Report Series. Prevalence and incidence of rare diseases: bibliographic data [Internet]. 2021 Jan [cited 2025 Jun 26]. Available from: http://www.orpha.net/orphacom/cahiers/docs/GB/Prevalence_of_rare_diseases_by_diseases.pdf.

Kavamura MI. Cardiofaciocutaneous syndrome. Orphanet [Internet]. 2017 [cited 2025 Jun 26]. Available from: https://www.orpha.net/consor/cgi-bin/Disease_Search.php?lng=EN&data_id=1559.

Rauen KA. Cardiofaciocutaneous syndrome. In: Adam MP, Mirzaa GM, Pagon RA, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993– [updated 2016 Nov 10; cited 2025 Jun 26]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1186/.

Sanri A, Gurkan H, Demir S. Cardiofaciocutaneous syndrome phenotype in a case with de novo KRAS pathogenic variant. Case Rep Genet. 2019;10:344–7. doi:10.1159/000504374.

Adachi M, Abe Y, Aoki Y, Matsubara Y. Epilepsy in RAS/MAPK syndrome: two cases of cardio-facio-cutaneous syndrome with epileptic encephalopathy and a literature review. Seizure. 2011;21:55–60. doi:10.1016/j.seizure.2011.07.013.

Castro M, Aquino A, Camilo C, Macieira J, Silva M. Cardio-facio-cutaneous syndrome: a case report. Int J Dermatol. 2002;41:923–5. doi:10.1046/j.1365-4362.2002.01631_2.x.

Kratz CP, Rapisuwon S, Reed H, Hasle H, Rosenberg PS. Cancer in Noonan, Costello, cardiofaciocutaneous and LEOPARD syndromes. Am J Med Genet C Semin Med Genet. 2011;157C(2):83–9. doi:10.1002/ajmg.c.30300.

Villani A, Greer MC, Kalish JM, et al. Recommendations for cancer surveillance in individuals with RASopathies and other rare genetic conditions with increased cancer risk. Clin Cancer Res. 2017;23(12):e83–90. doi:10.1158/1078-0432.CCR-17-0631.

Rauen KA, Maeda Y, Egense A, Tidyman WE. Familial cardio-facio-cutaneous syndrome: vertical transmission of the BRAF p.G464R pathogenic variant and review of the literature. Am J Med Genet A. 2021;185(2):469–75. doi:10.1002/ajmg.a.61995.

Gripp KW, Stabley DL, Nicholson L, Hoffman JD, Sol-Church K. Somatic mosaicism for an HRAS mutation causes Costello syndrome. Am J Med Genet A. 2006;140(20):2163–9. doi:10.1002/ajmg.a.31456.

Geoghegan S, King G, Henchliffe J, Ramsden SC, Barry RJ, Green AJ, O’Connell SM. A sibling pair with cardiofaciocutaneous syndrome (CFC) secondary to BRAF mutation with unaffected parents—the first cases of gonadal mosaicism in CFC? Am J Med Genet A. 2018;176(7):1637–40. doi:10.1002/ajmg.a.38725.

Martínez-Glez V, Tenorio J, Nevado J, et al. A six-attribute classification of genetic mosaicism. Genet Med. 2020;22(11):1743–57. doi:10.1038/s41436-020-0877-3.

MacConaill LE, Garcia E, Shivdasani P, et al. Prospective enterprise-level molecular genotyping of a cohort of cancer patients. J Mol Diagn. 2014;16(6):660–72. doi:10.1016/j.jmoldx.2014.06.004.

Chacon-Camacho OF, Lopez-Moreno D, Morales-Sanchez MA, et al. Expansion of the phenotypic spectrum and description of molecular findings in a cohort of patients with oculocutaneous mosaic RASopathies. Mol Genet Genomic Med. 2019;7(5):e625. doi:10.1002/mgg3.625.

Liaw FY, Huang CF, Wu YC, Wu BY. Elephantiasis nostras verrucosa: swelling with verrucose appearance of lower limbs. Can Fam Physician. 2012;58:e551–3.

Lim YH, Ovejero D, Sugarman JS, et al. Multilineage somatic activating mutations in HRAS and NRAS cause mosaic cutaneous and skeletal lesions, elevated FGF23 and hypophosphatemia. Hum Mol Genet. 2014;23(2):397–407. doi:10.1093/hmg/ddt429.

Nava C, Hanna N, Michot C, et al. Cardio-facio-cutaneous and Noonan syndromes due to mutations in the RAS/MAPK signalling pathway: genotype–phenotype relationships and overlap with Costello syndrome. J Med Genet. 2007;44(12):763–71. doi:10.1136/jmg.2007.050450.

Serrano C, Simonetti S, Hernández-Losa J, et al. BRAF V600E and KRAS G12S mutations in peripheral nerve sheath tumours. Histopathology. 2013;62(3):499–504. doi:10.1111/his.12021.

Alcantara KMM, Malapit JRP, Yu RTD, et al. Non-redundant and overlapping oncogenic readouts of non-canonical and novel colorectal cancer KRAS and NRAS mutants. Cells. 2019;8(12):1557. doi:10.3390/cells8121557.

Pao W, Wang TY, Riely GJ, et al. KRAS mutations and primary resistance of lung adenocarcinomas to gefitinib or erlotinib. PLoS Med. 2005;2(1):e17. doi:10.1371/journal.pmed.0020017.

Lee KH, Lee JS, Suh C, et al. Clinicopathologic significance of the K-ras gene codon 12 point mutation in stomach cancer: an analysis of 140 cases. Cancer. 1995;75(12):2794–801. doi:10.1002/1097-0142(19950615)75:12<2794::AID-CNCR2820751203>3.0.CO;2-F.

Matsuda K, Shimada A, Yoshida N, et al. Spontaneous improvement of hematologic abnormalities in patients having juvenile myelomonocytic leukemia with specific RAS mutations. Blood. 2007;109(12):5477–80. doi:10.1182/blood-2006-09-046649.

Pavithra S, Mallya H, Pai GS. Cardiofaciocutaneous syndrome: a rare entity. Indian J Dermatol. 2012;57(4):299–301.

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Published

2025-09-30

How to Cite

1.
Rodrigues AS, Nunes da Silva M de A, Azevedo A, Dias Carvalho SC, Miranda Sousa Álvaro R, Fortuna A. Unveiling the Complexity: Mosaic Cardiofaciocutaneous Syndrome Presenting with Exuberant Elephantiasis Nostras Verrucosa. BGMJ [Internet]. 2025 Sep. 30 [cited 2025 Dec. 6];34(3):132-6. Available from: https://revistas.rcaap.pt/bgmj/article/view/29304

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Section

Clinical Case Reports

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