Challenging Reproductive Genetic Counseling in Families at High Risk for Rare Genetic Syndromes – A Case Report with Possible Denys-Drash Syndrome

Hachmeriyan M¹, Andonova S², Levkova M^1*, Stoyanova M¹, Kalchev K³, Vasilev P³, Miteva V¹, Tsvetkova M¹, Bradinova I² and Angelova L¹

¹Department of Medical Genetics, University Hospital St Marina Varna, Medical University Varna, 9000 Varna, Bulgaria

²National Genetic Laboratory, UHOG “Maichin dom”, Medical University – Sofia, 1431 Sofia, Bulgaria

³Department of General and clinical pathology, University Hospital St Marina Varna, Medical University Varna, 9000 Varna, Bulgaria

*Corresponding Author : Levkova M
Department of Medical Genetics, University Hospital St Marina Varna, Medical University Varna, 9000 Varna, Bulgaria
Tel: +(35) 9885692182
E-mail: maria.levkova171@gmail.com

Received: May 16, 2018 Accepted: June 04, 2018 Published: June 11, 2018

Citation: Hachmeriyan M, Andonova S, Levkova M, Stoyanova M, Kalchev K, et al. (2018) Challenging Reproductive Genetic Counseling in Families at High Risk for Rare Genetic Syndromes – A Case Report with Possible Denys-Drash Syndrome . J Genet Disor Genet Rep 7:2. doi: 10.4172/2327-5790.1000172

Calculating the recurrence risk is an integral part of everyday practice of the genetic counselor, but certain difficulties occur when explaining it to the parents of a child with a rare dysmorphic syndrome.

We present a case of a family with first newborn with multiple anomalies and exitus letalis, registered on the second day. At birth, the baby presented with limb malformations. Additionally, a spontaneous pneumothorax, neonatal cerebral ischemia, and intraamniotic infection were diagnosed. A post-mortem examination revealed additional multiple internal malformations such as patent foramen ovale, bicornuate uterus, accessory spleen, bilateral adrenal hyperplasia, unilateral Wilm’s tumor of the left kidney, diffuse glomerular and interstitial fibrosis, and protein cylinders in dilated renal tubules.

Standard GTG banding karyotyping showed a normal male karyotype 46,XY,16qh+ that did not correspond to the female phenotype of the patient’s genitalia. Postmortem findings together with sex phenotype/genotype discordance suggested Denys-Drash syndrome as possible diagnosis. Amplification of all exons but exon 9 of WT1 gene was not successful on DNA extracted from formalin-fixed paraffin-embedded tissue (FFPET) sample. Sanger sequencing of exon 9 did not reveal a causative mutation. In current case the severe neonatal presentation and absence of molecular conformation complicated giving a certain prognosis for the recurrence risk. Reproductive genetic counseling in families with rare genetic conditions could be very challenging.