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Images in paediatric medicine
ARC syndrome: an expanding range of phenotypes
  1. K M Easthama,
  2. P J McKiernanc,
  3. D V Milfordd,
  4. P Ramanie,
  5. J Wyllieb,
  6. W van't Hofff,
  7. S A Lynchg,
  8. A A M Morrish
  1. aDepartment of Paediatrics, James Cook University Hospital, Marton Road, Middlesbrough, Cleveland TS4 3BW, UK, bDepartment of Neonatology, James Cook University Hospital, cLiver Unit, Children's Hospital NHS Trust, Birmingham B4 6NH, UK, dDepartment of Nephrology, Children's Hospital NHS Trust, Birmingham, eDepartment of Histopathology, Children's Hospital NHS Trust, Birmingham, fNephro-Urology Unit, Institute of Child Health, University College London Medical School, London, UK, gDepartment of Human Genetics, 19 Claremont Place, Newcastle upon Tyne NE2 4AA, UK, hDepartment of Metabolic Medicine, Great Ormond Street Hospital, London WC1N 3JH, UK
  1. Dr Morrismorria1{at}gosh.nhs.uk

Abstract

AIM To describe the clinical phenotype in infants with ARC syndrome, the association of arthrogryposis, renal tubular acidosis, and cholestasis.

METHODS The medical records for six patients with ARC syndrome were reviewed, presenting over 10 years to three paediatric referral centres.

RESULTS All patients had the typical pattern of arthrogryposis. Renal Fanconi syndrome was present in all but one patient, who presented with nephrogenic diabetes insipidus. Although all patients had severe cholestasis, serum γ glutamyltransferase values were normal. Many of our patients showed dysmorphic features or ichthyosis. All had recurrent febrile illnesses, diarrhoea, and failed to thrive. Blood films revealed abnormally large platelets.

CONCLUSIONS ARC syndrome exhibits notable clinical variability and may not be as rare as previously thought. The association of Fanconi syndrome, ichthyosis, dysmorphism, jaundice, and diarrhoea has previously been reported as a separate syndrome: our observations indicate that it is part of the ARC spectrum.

  • arthrogryposis
  • renal tubular acidosis
  • Fanconi syndrome
  • cholestasis

https://doi.org/10.1136/adc.85.5.415

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