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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="GeneReviews® [Internet]" /><meta name="citation_title" content="Hereditary Fibrosing Poikiloderma with Tendon Contractures, Myopathy, and Pulmonary Fibrosis" /><meta name="citation_publisher" content="University of Washington, Seattle" /><meta name="citation_date" content="2021/09/09" /><meta name="citation_author" content="Sandra Mercier" /><meta name="citation_author" content="Sébastien Küry" /><meta name="citation_author" content="Sébastien Barbarot" /><meta name="citation_pmid" content="27748098" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK390610/" /><meta name="citation_keywords" content="POIKTMP" /><meta name="citation_keywords" content="POIKTMP" /><meta name="citation_keywords" content="Serine protease FAM111B" /><meta name="citation_keywords" content="FAM111B" /><meta name="citation_keywords" content="Hereditary Fibrosing Poikiloderma with Tendon Contractures, Myopathy, and Pulmonary Fibrosis" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Hereditary Fibrosing Poikiloderma with Tendon Contractures, Myopathy, and Pulmonary Fibrosis" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="University of Washington, Seattle" /><meta name="DC.Contributor" content="Sandra Mercier" /><meta name="DC.Contributor" content="Sébastien Küry" /><meta name="DC.Contributor" content="Sébastien Barbarot" /><meta name="DC.Date" content="2021/09/09" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK390610/" /><meta name="description" content="Hereditary fibrosing poikiloderma with tendon contractures, myopathy, and pulmonary fibrosis (POIKTMP) is characterized by the skin findings of poikiloderma (typically beginning in the first six months and mainly localized to the face), hypohidrosis with heat intolerance, mild lymphedema of the extremities, chronic erythematous and scaly skin lesions on the extremities, sclerosis of the digits, and mild palmoplantar keratoderma. Scalp hair, eyelashes, and/or eyebrows are typically sparse. Muscle contractures are usually seen in childhood and can be present as early as age two years. The majority of affected individuals develop progressive weakness of the proximal and distal muscles of all four limbs. Some adults develop progressive interstitial pulmonary fibrosis, which can be life threatening within three to four years after respiratory symptoms appear. Other features are exocrine pancreatic insufficiency, liver impairment, hematologic abnormalities, relative short stature, and cataract." /><meta name="og:title" content="Hereditary Fibrosing Poikiloderma with Tendon Contractures, Myopathy, and Pulmonary Fibrosis" /><meta name="og:type" content="book" /><meta name="og:description" content="Hereditary fibrosing poikiloderma with tendon contractures, myopathy, and pulmonary fibrosis (POIKTMP) is characterized by the skin findings of poikiloderma (typically beginning in the first six months and mainly localized to the face), hypohidrosis with heat intolerance, mild lymphedema of the extremities, chronic erythematous and scaly skin lesions on the extremities, sclerosis of the digits, and mild palmoplantar keratoderma. Scalp hair, eyelashes, and/or eyebrows are typically sparse. Muscle contractures are usually seen in childhood and can be present as early as age two years. The majority of affected individuals develop progressive weakness of the proximal and distal muscles of all four limbs. Some adults develop progressive interstitial pulmonary fibrosis, which can be life threatening within three to four years after respiratory symptoms appear. 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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>Adam MP, Feldman J, Mirzaa GM, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2025. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="All GeneReviews" href="/books/n/gene/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-gene-lrg.png" alt="Cover of GeneReviews®" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>GeneReviews<sup>®</sup> [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK390610_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK390610_dtls__"><div>Adam MP, Feldman J, Mirzaa GM, et al., editors.</div><div>Seattle (WA): <a href="http://www.washington.edu" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">University of Washington, Seattle</a>; 1993-2025.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/gene/">GeneReviews by Title</a></li></ul></div><div class="bk_noprnt"><form method="get" action="/books/n/gene/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search GeneReviews" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search GeneReviews" submit="false" style="padding: 0.1em 0.4em;" /></div></form><div><ul class="inline_list"><li><a href="/books/n/gene/advanced/">GeneReviews Advanced Search</a></li><li style="margin-left:.5em"><a href="/books/n/gene/helpadvsearch/">Help</a></li></ul></div></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/gene/dystonia-ov/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/gene/folate-mal/" title="Next page in this title">Next ></a></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK390610_"><span class="title" itemprop="name">Hereditary Fibrosing Poikiloderma with Tendon Contractures, Myopathy, and Pulmonary Fibrosis</span></h1><div itemprop="alternativeHeadline" class="subtitle whole_rhythm">Synonym: POIKTMP</div><p class="contrib-group"><span itemprop="author">Sandra Mercier</span>, MD, PhD, <span itemprop="author">Sébastien Küry</span>, DVM, PhD, and <span itemprop="author">Sébastien Barbarot</span>, MD, PhD.</p><a data-jig="ncbitoggler" href="#__NBK390610_ai__" style="border:0;text-decoration:none">Author Information and Affiliations</a><div style="display:none" class="ui-widget" id="__NBK390610_ai__"><div class="contrib half_rhythm"><span itemprop="author">Sandra Mercier</span>, MD, PhD<div class="affiliation small">Service de Génétique médicale – CHU
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Nantes, France<div><span class="email-label">Email: </span><a href="mailto:dev@null" data-email="rf.setnan-uhc@reicrem.ardnas" class="oemail">rf.setnan-uhc@reicrem.ardnas</a></div></div></div><div class="contrib half_rhythm"><span itemprop="author">Sébastien Küry</span>, DVM, PhD<div class="affiliation small">Service de Génétique médicale – CHU
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Nantes, France<div><span class="email-label">Email: </span><a href="mailto:dev@null" data-email="rf.setnan-uhc@yruk.neitsabes" class="oemail">rf.setnan-uhc@yruk.neitsabes</a></div></div></div><div class="contrib half_rhythm"><span itemprop="author">Sébastien Barbarot</span>, MD, PhD<div class="affiliation small">Service de Génétique médicale – CHU
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Nantes, France<div><span class="email-label">Email: </span><a href="mailto:dev@null" data-email="rf.setnan-uhc@torabrab.neitsabes" class="oemail">rf.setnan-uhc@torabrab.neitsabes</a></div></div></div></div><p class="small">Initial Posting: <span itemprop="datePublished">October 13, 2016</span>; Last Revision: <span itemprop="dateModified">September 9, 2021</span>.</p><p><em>Estimated reading time: 17 minutes</em></p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="hfpoik-tmp.Summary" itemprop="description"><h2 id="_hfpoik-tmp_Summary_">Summary</h2><div><h4 class="inline">Clinical characteristics.</h4><p>Hereditary fibrosing poikiloderma with tendon contractures, myopathy, and pulmonary fibrosis (POIKTMP) is characterized by the skin findings of poikiloderma (typically beginning in the first six months and mainly localized to the face), hypohidrosis with heat intolerance, mild lymphedema of the extremities, chronic erythematous and scaly skin lesions on the extremities, sclerosis of the digits, and mild palmoplantar keratoderma. Scalp hair, eyelashes, and/or eyebrows are typically sparse. Muscle contractures are usually seen in childhood and can be present as early as age two years. The majority of affected individuals develop progressive weakness of the proximal and distal muscles of all four limbs. Some adults develop progressive interstitial pulmonary fibrosis, which can be life threatening within three to four years after respiratory symptoms appear. Other features are exocrine pancreatic insufficiency, liver impairment, hematologic abnormalities, relative short stature, and cataract.</p></div><div><h4 class="inline">Diagnosis/testing.</h4><p>The diagnosis of POIKTMP is established in a <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a> with early-onset poikiloderma with other findings, especially muscle contractures and/or muscle weakness and a <a class="def" href="/books/n/gene/glossary/def-item/heterozygous/">heterozygous</a> <a class="def" href="/books/n/gene/glossary/def-item/missense/">missense</a> <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a> in <i>FAM111B</i> identified by <a class="def" href="/books/n/gene/glossary/def-item/molecular-genetic-testing/">molecular genetic testing</a>.</p></div><div><h4 class="inline">Management.</h4><p><i>Treatment of manifestations:</i> Dermatologic manifestations are treated with avoidance of excessive sun exposure and use of sunscreens with both UVA and UVB protection; avoidance of excessive heat exposure and control of fever, especially in early childhood; routine management of lymphedema; emollients, topical steroids for eczema-like lesions. For older individuals, pulsed dye laser may be an option for cosmesis of the telangiectatic component of the rash. Physical therapy and exercise to promote mobility and prevent contractures. Use of self-inflating manual-ventilation bag or mechanical insufflation-exsufflation device if needed for lung disease; noninvasive ventilation if needed. Pancreatic enzyme supplementation for pancreatic exocrine insufficiency.</p><p><i>Surveillance:</i> Annual surveillance (or frequency as needed) includes dermatologic examination, physical therapy assessment for muscle weakness and/or contractures, assessment for orthopedic complications (contractures, especially of the Achilles tendon, and scoliosis), pulmonary function testing, serum transaminases (SGOT, SGPT), alkaline phosphatase, gamma-glutamyl transferase, blood ionogram including calcium, TSH, complete blood count with differential), and ophthalmologic examination.</p><p><i>Agents/circumstances to avoid:</i> Excessive sun exposure (may exacerbate the rash), exposure to heat because of heat intolerance.</p></div><div><h4 class="inline">Genetic counseling.</h4><p>POIKTMP is inherited in an <a class="def" href="/books/n/gene/glossary/def-item/autosomal-dominant/">autosomal dominant</a> manner. In approximately 50% of affected individuals, the <i>FAM111B</i> <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a> is inherited and in approximately 50% it is <a class="def" href="/books/n/gene/glossary/def-item/de-novo/"><i>de novo</i></a>. Each child of an individual with POIKTMP has a 50% chance of inheriting the <i>FAM111B</i> pathogenic variant. Once the <i>FAM111B</i> pathogenic variant has been identified in an affected family member, prenatal and <a class="def" href="/books/n/gene/glossary/def-item/preimplantation-genetic-testing/">preimplantation genetic testing</a> are possible.</p></div></div><div id="hfpoik-tmp.Diagnosis"><h2 id="_hfpoik-tmp_Diagnosis_">Diagnosis</h2><div id="hfpoik-tmp.Suggestive_Findings"><h3>Suggestive Findings</h3><p>Hereditary fibrosing poikiloderma with tendon contractures, myopathy, and pulmonary fibrosis (POIKTMP) <b>should be suspected</b> in individuals with the following clinical and imaging findings.</p><p>
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<b>Clinical findings</b>
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</p><ul><li class="half_rhythm"><div>Skin (<a class="figpopup" href="/books/NBK390610/figure/hfpoik-tmp.F1/?report=objectonly" target="object" rid-figpopup="fighfpoiktmpF1" rid-ob="figobhfpoiktmpF1">Figure 1</a> and <a class="figpopup" href="/books/NBK390610/figure/hfpoik-tmp.F2/?report=objectonly" target="object" rid-figpopup="fighfpoiktmpF2" rid-ob="figobhfpoiktmpF2">Figure 2</a>):</div><ul><li class="half_rhythm"><div>Early-onset poikiloderma (characterized by erythema of the cheeks and face, skin atrophy, telangiectasias, and mottled pigmentation)</div></li><li class="half_rhythm"><div>Hypotrichosis with sparse scalp hair, sparse or absent eyelashes and/or eyebrows</div></li><li class="half_rhythm"><div>Hypohidrosis with heat intolerance</div></li><li class="half_rhythm"><div>Mild lymphedema of the extremities</div></li></ul></li><li class="half_rhythm"><div>Multiple contractures, in particular triceps surae contractures in childhood</div></li><li class="half_rhythm"><div>Myopathy with diffuse progressive muscular weakness, scoliosis</div></li><li class="half_rhythm"><div>Restrictive pulmonary syndrome and/or pulmonary fibrosis</div></li><li class="half_rhythm"><div>Exocrine pancreatic insufficiency</div></li><li class="half_rhythm"><div>Liver impairment</div></li><li class="half_rhythm"><div>Hematologic abnormalities (e.g., eosinophilia, thrombocytopenia, and/or bone marrow hypocellularity)</div></li><li class="half_rhythm"><div>Other</div><ul><li class="half_rhythm"><div>Relative short stature</div></li><li class="half_rhythm"><div>Cataract</div></li><li class="half_rhythm"><div>Nail dystrophy</div></li></ul></li></ul><div class="iconblock whole_rhythm clearfix ten_col fig" id="fighfpoiktmpF1" co-legend-rid="figlgndhfpoiktmpF1"><a href="/books/NBK390610/figure/hfpoik-tmp.F1/?report=objectonly" target="object" title="Figure 1. " class="img_link icnblk_img figpopup" rid-figpopup="fighfpoiktmpF1" rid-ob="figobhfpoiktmpF1"><img class="small-thumb" src="/books/NBK390610/bin/hfpoik-tmp-Image001.gif" src-large="/books/NBK390610/bin/hfpoik-tmp-Image001.jpg" alt="Figure 1. " /></a><div class="icnblk_cntnt" id="figlgndhfpoiktmpF1"><h4 id="hfpoik-tmp.F1"><a href="/books/NBK390610/figure/hfpoik-tmp.F1/?report=objectonly" target="object" rid-ob="figobhfpoiktmpF1">Figure 1. </a></h4><p class="float-caption no_bottom_margin">Facial and scalp skin lesions A-E. Poikiloderma and alopecia of the scalp, eyebrows, and eyelashes in childhood</p></div></div><div class="iconblock whole_rhythm clearfix ten_col fig" id="fighfpoiktmpF2" co-legend-rid="figlgndhfpoiktmpF2"><a href="/books/NBK390610/figure/hfpoik-tmp.F2/?report=objectonly" target="object" title="Figure 2. " class="img_link icnblk_img figpopup" rid-figpopup="fighfpoiktmpF2" rid-ob="figobhfpoiktmpF2"><img class="small-thumb" src="/books/NBK390610/bin/hfpoik-tmp-Image002.gif" src-large="/books/NBK390610/bin/hfpoik-tmp-Image002.jpg" alt="Figure 2. " /></a><div class="icnblk_cntnt" id="figlgndhfpoiktmpF2"><h4 id="hfpoik-tmp.F2"><a href="/books/NBK390610/figure/hfpoik-tmp.F2/?report=objectonly" target="object" rid-ob="figobhfpoiktmpF2">Figure 2. </a></h4><p class="float-caption no_bottom_margin">Skin lesions of the upper and lower limbs A. Eczema-like and psoriasis-like dermatosis of the upper limbs</p></div></div><p>
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<b>Imaging findings</b>
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</p><ul><li class="half_rhythm"><div>See <a class="figpopup" href="/books/NBK390610/figure/hfpoik-tmp.F3/?report=objectonly" target="object" rid-figpopup="fighfpoiktmpF3" rid-ob="figobhfpoiktmpF3">Figure 3</a>. Muscle MRI typically shows severe diffuse fatty infiltration of the legs, especially:</div><ul><li class="half_rhythm"><div>The vastus lateralis muscles (with relative sparing of the tibialis posterior); and</div></li><li class="half_rhythm"><div>The anterior compartment of thighs (with relative sparing of posterior compartment).</div></li></ul></li><li class="half_rhythm"><div>These findings can confirm muscle involvement in asymptomatic individuals.</div></li></ul><div class="iconblock whole_rhythm clearfix ten_col fig" id="fighfpoiktmpF3" co-legend-rid="figlgndhfpoiktmpF3"><a href="/books/NBK390610/figure/hfpoik-tmp.F3/?report=objectonly" target="object" title="Figure 3. " class="img_link icnblk_img figpopup" rid-figpopup="fighfpoiktmpF3" rid-ob="figobhfpoiktmpF3"><img class="small-thumb" src="/books/NBK390610/bin/hfpoik-tmp-Image003.gif" src-large="/books/NBK390610/bin/hfpoik-tmp-Image003.jpg" alt="Figure 3. " /></a><div class="icnblk_cntnt" id="figlgndhfpoiktmpF3"><h4 id="hfpoik-tmp.F3"><a href="/books/NBK390610/figure/hfpoik-tmp.F3/?report=objectonly" target="object" rid-ob="figobhfpoiktmpF3">Figure 3. </a></h4><p class="float-caption no_bottom_margin">Muscle MRI (coronal images of the thighs and calves; T<sub>1</sub>-weighted sequence) A. Diffuse bright appearance of the anterior compartment of the thighs (upper images), particularly in the vastus lateralis muscles, and the posterior compartment of the calves <a href="/books/NBK390610/figure/hfpoik-tmp.F3/?report=objectonly" target="object" rid-ob="figobhfpoiktmpF3">(more...)</a></p></div></div></div><div id="hfpoik-tmp.Establishing_the_Diagnosis"><h3>Establishing the Diagnosis</h3><p>The diagnosis of POIKTMP <b>is established</b> in a <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a> with early-onset poikiloderma with other findings (especially muscle contractures and/or muscle weakness) and a <a class="def" href="/books/n/gene/glossary/def-item/heterozygous/">heterozygous</a> pathogenic <a class="def" href="/books/n/gene/glossary/def-item/missense/">missense</a> variant in <i>FAM111B</i> identified on <a class="def" href="/books/n/gene/glossary/def-item/molecular-genetic-testing/">molecular genetic testing</a> (<a href="/books/NBK390610/table/hfpoik-tmp.T.molecular_genetic_testing_u/?report=objectonly" target="object" rid-ob="figobhfpoiktmpTmoleculargenetictestingu">Table 1</a>).</p><p>Molecular genetic testing approaches can include a combination of <b><a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a>-targeted testing</b> (single-gene testing, <a class="def" href="/books/n/gene/glossary/def-item/multigene-panel/">multigene panel</a>) and <b>comprehensive</b>
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<b><a class="def" href="/books/n/gene/glossary/def-item/genomic/">genomic</a> testing</b> (<a class="def" href="/books/n/gene/glossary/def-item/exome-sequencing/">exome sequencing</a>, <a class="def" href="/books/n/gene/glossary/def-item/genome-sequencing/">genome sequencing</a>) depending on the <a class="def" href="/books/n/gene/glossary/def-item/phenotype/">phenotype</a>.</p><p>Gene-targeted testing requires that the clinician determine which <a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a>(s) are likely involved, whereas <a class="def" href="/books/n/gene/glossary/def-item/genomic/">genomic</a> testing does not. Individuals with the distinctive findings described in <a href="#hfpoik-tmp.Suggestive_Findings">Suggestive Findings</a> are likely to be diagnosed using gene-targeted testing (see <a href="#hfpoik-tmp.Option_1">Option 1</a>), whereas those in whom the diagnosis of POIKTMP has not been considered are more likely to be diagnosed using genomic testing (see <a href="#hfpoik-tmp.Option_2">Option 2</a>).</p><div id="hfpoik-tmp.Option_1"><h4>Option 1</h4><p><b>Single-<a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a> testing.</b> Sequence analysis of <i>FAM111B</i> to detect small intragenic deletions/insertions and <a class="def" href="/books/n/gene/glossary/def-item/missense/">missense</a>, <a class="def" href="/books/n/gene/glossary/def-item/nonsense-variant/">nonsense</a>, and <a class="def" href="/books/n/gene/glossary/def-item/splice-site/">splice site</a> variants.</p><p>Gene-targeted <a class="def" href="/books/n/gene/glossary/def-item/deletion-duplication-analysis/">deletion/duplication analysis</a> may be performed; however, since POIKTMP likely occurs as the result of a <a class="def" href="/books/n/gene/glossary/def-item/dominant-negative/">dominant-negative</a> genetic mechanism and since large intragenic deletions or duplications have not been reported, testing for intragenic deletions or duplications is unlikely to identify a disease-causing variant (see <a href="#hfpoik-tmp.Molecular_Genetics">Molecular Genetics</a>).</p><p><b>A <a class="def" href="/books/n/gene/glossary/def-item/multigene-panel/">multigene panel</a></b> that includes <i>FAM111B</i> and other genes of interest (see <a href="#hfpoik-tmp.Differential_Diagnosis">Differential Diagnosis</a>) may also be considered. Note: (1) The genes included in the panel and the diagnostic <a class="def" href="/books/n/gene/glossary/def-item/sensitivity/">sensitivity</a> of the testing used for each <a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a> vary by laboratory and are likely to change over time. (2) Some multigene panels may include genes not associated with the condition discussed in this <i>GeneReview</i> (e.g., <i>RECQL4</i>, <i>USB1</i>, <i>FERMT1</i>); thus, clinicians need to determine which multigene panel provides the best opportunity to identify the genetic cause of the condition while limiting identification of pathogenic variants in genes that do not explain the underlying <a class="def" href="/books/n/gene/glossary/def-item/phenotype/">phenotype</a>. (3) Methods used in a panel may include <a class="def" href="/books/n/gene/glossary/def-item/sequence-analysis/">sequence analysis</a>, <a class="def" href="/books/n/gene/glossary/def-item/deletion-duplication-analysis/">deletion/duplication analysis</a>, and/or other non-sequencing-based tests.</p><p>For an introduction to multigene panels click <a href="/books/n/gene/app5/#app5.Multigene_Panels">here</a>. More detailed information for clinicians ordering genetic tests can be found <a href="/books/n/gene/app5/#app5.Multigene_Panels_FAQs">here</a>.</p></div><div id="hfpoik-tmp.Option_2"><h4>Option 2</h4><p><b>Comprehensive</b>
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<b><a class="def" href="/books/n/gene/glossary/def-item/genomic/">genomic</a> testing</b> does not require the clinician to determine which <a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a> is likely involved. <b>Exome sequencing</b> is most commonly used; <b><a class="def" href="/books/n/gene/glossary/def-item/genome-sequencing/">genome sequencing</a></b> is also possible.</p><p>For an introduction to comprehensive <a class="def" href="/books/n/gene/glossary/def-item/genomic/">genomic</a> testing click <a href="/books/n/gene/app5/#app5.Comprehensive_Genomic_Testing">here</a>. More detailed information for clinicians ordering genomic testing can be found <a href="/books/n/gene/app5/#app5.Comprehensive_Genomic_Testing_1">here</a>.</p><div id="hfpoik-tmp.T.molecular_genetic_testing_u" class="table"><h3><span class="label">Table 1. </span></h3><div class="caption"><p>Molecular Genetic Testing Used in Hereditary Fibrosing Poikiloderma with Tendon Contractures, Myopathy, and Pulmonary Fibrosis</p></div><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK390610/table/hfpoik-tmp.T.molecular_genetic_testing_u/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__hfpoik-tmp.T.molecular_genetic_testing_u_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_hfpoik-tmp.T.molecular_genetic_testing_u_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Gene <sup>1</sup></th><th id="hd_h_hfpoik-tmp.T.molecular_genetic_testing_u_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Method</th><th id="hd_h_hfpoik-tmp.T.molecular_genetic_testing_u_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Proportion of Probands with a Pathogenic Variant <sup>2</sup> Detectable by Method</th></tr></thead><tbody><tr><td headers="hd_h_hfpoik-tmp.T.molecular_genetic_testing_u_1_1_1_1" rowspan="2" scope="row" colspan="1" style="text-align:left;vertical-align:middle;">
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<i>FAM111B</i>
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</td><td headers="hd_h_hfpoik-tmp.T.molecular_genetic_testing_u_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Sequence analysis <sup>3</sup></td><td headers="hd_h_hfpoik-tmp.T.molecular_genetic_testing_u_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">100% <sup>4</sup></td></tr><tr><td headers="hd_h_hfpoik-tmp.T.molecular_genetic_testing_u_1_1_1_2" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">Gene-targeted <a class="def" href="/books/n/gene/glossary/def-item/deletion-duplication-analysis/">deletion/duplication analysis</a> <sup>5</sup></td><td headers="hd_h_hfpoik-tmp.T.molecular_genetic_testing_u_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">None reported <sup>6</sup></td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>1. </dt><dd><div id="hfpoik-tmp.TF.1.1"><p class="no_margin">See <a href="/books/NBK390610/#hfpoik-tmp.molgen.TA">Table A. Genes and Databases</a> for <a class="def" href="/books/n/gene/glossary/def-item/chromosome/">chromosome</a> <a class="def" href="/books/n/gene/glossary/def-item/locus/">locus</a> and protein.</p></div></dd><dt>2. </dt><dd><div id="hfpoik-tmp.TF.1.2"><p class="no_margin">See <a href="#hfpoik-tmp.Molecular_Genetics">Molecular Genetics</a> for information on variants detected in this <a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a>.</p></div></dd><dt>3. </dt><dd><div id="hfpoik-tmp.TF.1.3"><p class="no_margin">Sequence analysis detects variants that are benign, <a class="def" href="/books/n/gene/glossary/def-item/likely-benign/">likely benign</a>, of <a class="def" href="/books/n/gene/glossary/def-item/uncertain-significance/">uncertain significance</a>, <a class="def" href="/books/n/gene/glossary/def-item/likely-pathogenic/">likely pathogenic</a>, or pathogenic. Variants may include small intragenic deletions/insertions and <a class="def" href="/books/n/gene/glossary/def-item/missense/">missense</a>, <a class="def" href="/books/n/gene/glossary/def-item/nonsense-variant/">nonsense</a>, and <a class="def" href="/books/n/gene/glossary/def-item/splice-site/">splice site</a> variants; typically, <a class="def" href="/books/n/gene/glossary/def-item/exon/">exon</a> or whole-<a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a> deletions/duplications are not detected. For issues to consider in interpretation of <a class="def" href="/books/n/gene/glossary/def-item/sequence-analysis/">sequence analysis</a> results, click <a href="/books/n/gene/app2/">here</a>.</p></div></dd><dt>4. </dt><dd><div id="hfpoik-tmp.TF.1.4"><p class="no_margin"><a class="bk_pop" href="#hfpoik-tmp.REF.mercier.2013.1100">Mercier et al [2013]</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.mercier.2015.135">Mercier et al [2015]</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.seo.2016.858">Seo et al [2016]</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.takeichi.2017.534">Takeichi et al [2017]</a></p></div></dd><dt>5. </dt><dd><div id="hfpoik-tmp.TF.1.5"><p class="no_margin">Gene-targeted <a class="def" href="/books/n/gene/glossary/def-item/deletion-duplication-analysis/">deletion/duplication analysis</a> detects intragenic deletions or duplications. Methods used may include <a class="def" href="/books/n/gene/glossary/def-item/quantitative-pcr/">quantitative PCR</a>, long-range PCR, multiplex ligation-dependent probe amplification (MLPA), and a <a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a>-targeted microarray designed to detect single-<a class="def" href="/books/n/gene/glossary/def-item/exon/">exon</a> deletions or duplications.</p></div></dd><dt>6. </dt><dd><div id="hfpoik-tmp.TF.1.6"><p class="no_margin">The spectrum of variants detected in affected individuals and functional studies [Author, unpublished observations] suggest a <a class="def" href="/books/n/gene/glossary/def-item/dominant-negative/">dominant-negative</a> mechanism of disease; therefore, <a class="def" href="/books/n/gene/glossary/def-item/deletion/">deletion</a>/<a class="def" href="/books/n/gene/glossary/def-item/duplication/">duplication</a> testing is unlikely to detect a disease-causing variant.</p></div></dd></dl></div></div></div></div></div></div><div id="hfpoik-tmp.Clinical_Characteristics"><h2 id="_hfpoik-tmp_Clinical_Characteristics_">Clinical Characteristics</h2><div id="hfpoik-tmp.Clinical_Description"><h3>Clinical Description</h3><p>To date, 31 individuals have been identified with a <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a> in <i>FAM111B</i> [<a class="bk_pop" href="#hfpoik-tmp.REF.mercier.2013.1100">Mercier et al 2013</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.mercier.2015.135">Mercier et al 2015</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.seo.2016.858">Seo et al 2016</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.takeichi.2017.534">Takeichi et al 2017</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.goussot.2017.143">Goussot et al 2017</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.kazlouskaya.2018.e443">Kazlouskaya et al 2018</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.zhang.2019.1014">Zhang et al 2019</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.chen.2019.695">Chen et al 2019</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.chasseuil.2019.862">Chasseuil et al 2019</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.dokic.2020.1217">Dokic et al 2020</a>]. The following description of the phenotypic features associated with this condition is based on these reports.</p><p>Individuals with hereditary fibrosing poikiloderma with tendon contractures, myopathy, and pulmonary fibrosis (POIKTMP) can exhibit few or many of the associated clinical features. The severity of the features (e.g., skin or muscle abnormalities) can vary. Intrafamilial clinical variability has been observed [<a class="bk_pop" href="#hfpoik-tmp.REF.khumalo.2006.1057">Khumalo et al 2006</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.seo.2016.858">Seo et al 2016</a>].</p><div id="hfpoik-tmp.Skin"><h4>Skin</h4><p>Skin abnormalities are the earliest findings. Of note, skin lesions – particularly facial poikiloderma – improve with time.</p><p><b>Poikiloderma</b> appears during early infancy, typically in the first six months. It is mainly localized to the face (<a class="figpopup" href="/books/NBK390610/figure/hfpoik-tmp.F1/?report=objectonly" target="object" rid-figpopup="fighfpoiktmpF1" rid-ob="figobhfpoiktmpF1">Figure 1</a>). Transient exacerbations of facial erythema are seen following sun exposure. Mottled pigmentation is also a constituent part of poikiloderma.</p><p><b>Hypohidrosis</b> with heat intolerance is observed in most.</p><p><b>Lymphedema</b> of the lower and/or upper extremities may be present in childhood and is usually mild; it can be complicated by episodes of cellulitis.</p><p><b>Chronic erythematous and scaly skin lesions</b> described as eczema-like, ichthyosis-like, or psoriasis-like lesions are often observed on the extremities.</p><p><b>Sclerosis</b> of the digits and mild palmoplantar keratoderma may also be observed.</p><p><b>Hair/nails.</b> Sparse scalp hair and sparse or absent eyelashes and/or eyebrows of variable severity are found in almost all affected individuals. Four affected individuals had mild nail dysplasia.</p></div><div id="hfpoik-tmp.Muscle"><h4>Muscle</h4><p><b>Muscle contractures</b> are usually seen in childhood and can be present as early as age two years. The most commonly affected muscles are the triceps surae, leading to a shortening of the Achilles tendons and varus deformities of the feet. Contractures of upper limbs (biceps brachii and carpal extensors) are also observed.</p><p><b>Myopathy.</b> The majority of affected individuals develop progressive weakness of the proximal and distal muscles of all four limbs; the first manifestations (observed in lower limbs) are proximal rather than distal. Variability of muscle weakness ranges from loss of ambulation in childhood to absence of symptoms in adulthood [<a class="bk_pop" href="#hfpoik-tmp.REF.mercier.2013.1100">Mercier et al 2013</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.mercier.2015.135">Mercier et al 2015</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.seo.2016.858">Seo et al 2016</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.takeichi.2017.534">Takeichi et al 2017</a>].</p><p>Muscle weakness is generally associated with muscle atrophy and sometimes thoracolumbar scoliosis.</p><p>Serum creatine kinase is either normal or slightly increased. When performed, electromyography may show a normal or myopathic pattern.</p></div><div id="hfpoik-tmp.Lung"><h4>Lung</h4><p>Recurrent bronchitis can be observed. Abnormal lung function with restrictive pulmonary disease is common.</p><p>Some adults develop progressive interstitial pulmonary fibrosis, manifest as progressive breathlessness and dry cough; it can be life threatening within three to four years after the first respiratory symptoms appear.</p></div><div id="hfpoik-tmp.Gastrointestinal"><h4>Gastrointestinal</h4><p><b>Pancreatic exocrine insufficiency</b> (common in affected individuals) typically begins in childhood. Manifestations include fatty stools and diarrhea leading to chronic malabsorption of fats and lipid-soluble vitamins if not treated. Diagnosis is confirmed based on fecal elastase deficiency.</p><p><b>Liver impairment</b> (reported in a few affected individuals) manifests initially as mildly elevated transaminases, alkaline phosphatase, gamma-glutamyl transferase, and/or bilirubin. One individual had hepatomegaly and cholestasis [<a class="bk_pop" href="#hfpoik-tmp.REF.mercier.2013.1100">Mercier et al 2013</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.mercier.2015.135">Mercier et al 2015</a>]. Another individual reported has transaminitis and lymphocytic ductulitis [<a class="bk_pop" href="#hfpoik-tmp.REF.dokic.2020.1217">Dokic et al 2020</a>].</p></div><div id="hfpoik-tmp.Other_Features"><h4>Other Features</h4><p><b>Relative short stature</b> and/or poor weight gain associated with delayed puberty have been reported.</p><p><b>Hematologic findings</b> include eosinophilia or mild thrombocytopenia in some. Bone marrow hypocellularity was reported in a multiplex family [<a class="bk_pop" href="#hfpoik-tmp.REF.seo.2016.858">Seo et al 2016</a>].</p><p><b>Hypothyroidism</b> was described in a girl age 14 years [<a class="bk_pop" href="#hfpoik-tmp.REF.takeichi.2017.534">Takeichi et al 2017</a>].</p><p><b>Eye.</b> Cataract was reported in a girl age 13 years [<a class="bk_pop" href="#hfpoik-tmp.REF.mercier.2015.135">Mercier et al 2015</a>].</p><p><b>Cognitive development and function</b> are normal. Of note, one individual had schizophrenia [<a class="bk_pop" href="#hfpoik-tmp.REF.mercier.2015.135">Mercier et al 2015</a>], which could be an incidental association.</p></div><div id="hfpoik-tmp.Histopathology"><h4>Histopathology</h4><p><b>Muscle histology</b> shows extensive fatty infiltration. Residual muscle tissue is composed of fragmented muscle fascicles with either normal fibers or atrophic fibers with central nuclei (<a class="figpopup" href="/books/NBK390610/figure/hfpoik-tmp.F4/?report=objectonly" target="object" rid-figpopup="fighfpoiktmpF4" rid-ob="figobhfpoiktmpF4">Figure 4 A-D</a>). No neuropathic features (i.e., normal ATPase pattern) or mitochondrial network abnormalities are found on histochemistry or immunolabeling. Western blot analysis can show a secondary reduction of calpain.</p><div class="iconblock whole_rhythm clearfix ten_col fig" id="fighfpoiktmpF4" co-legend-rid="figlgndhfpoiktmpF4"><a href="/books/NBK390610/figure/hfpoik-tmp.F4/?report=objectonly" target="object" title="Figure 4" class="img_link icnblk_img figpopup" rid-figpopup="fighfpoiktmpF4" rid-ob="figobhfpoiktmpF4"><img class="small-thumb" src="/books/NBK390610/bin/hfpoik-tmp-Image004.gif" src-large="/books/NBK390610/bin/hfpoik-tmp-Image004.jpg" alt="Figure 4. A-D." /></a><div class="icnblk_cntnt" id="figlgndhfpoiktmpF4"><h4 id="hfpoik-tmp.F4"><a href="/books/NBK390610/figure/hfpoik-tmp.F4/?report=objectonly" target="object" rid-ob="figobhfpoiktmpF4">Figure 4</a></h4><p class="float-caption no_bottom_margin">A-D. Muscle histology: A, B. Fatty tissue, fragmented muscle fascicles next to normal fascicles</p></div></div><p><b>Skin histology</b> shows a characteristic pattern of epidermal atrophy with collagen sclerosis and elastic degeneration in the superficial and deep dermis. Elastic globes in the papillary dermis are associated with a diffuse mild collagen sclerosis (<a class="figpopup" href="/books/NBK390610/figure/hfpoik-tmp.F4/?report=objectonly" target="object" rid-figpopup="fighfpoiktmpF4" rid-ob="figobhfpoiktmpF4">Figure 4 E-F</a>).</p><p><b>Postmortem findings</b> of one affected member of a South African family revealed diffuse fatty infiltration and fibrosis of organs including the lungs, esophagus, and pancreas [<a class="bk_pop" href="#hfpoik-tmp.REF.khumalo.2006.1057">Khumalo et al 2006</a>].</p></div></div><div id="hfpoik-tmp.GenotypePhenotype_Correlation"><h3>Genotype-Phenotype Correlations</h3><p>POIKTMP is most frequently caused by heterozygosity for <a class="def" href="/books/n/gene/glossary/def-item/missense/">missense</a> <i>FAM111B</i> pathogenic variants in the predicted trypsin-like cysteine/serine peptidase <a class="def" href="/books/n/gene/glossary/def-item/domain/">domain</a> of the protein, in particular in the loop of the functional domain.</p><ul><li class="half_rhythm"><div>Upstream variants located outside the loop (codons 421, 430) appear to be associated with a less severe <a class="def" href="/books/n/gene/glossary/def-item/phenotype/">phenotype</a>, especially regarding muscle features [<a class="bk_pop" href="#hfpoik-tmp.REF.mercier.2015.135">Mercier et al 2015</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.seo.2016.858">Seo et al 2016</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.takeichi.2017.534">Takeichi et al 2017</a>].</div></li><li class="half_rhythm"><div>The <a class="def" href="/books/n/gene/glossary/def-item/phenotype/">phenotype</a> of pathogenic variants in codon 621 appears to be less severe than the phenotype observed with pathogenic variants in codons 625, 627, and 628 [<a class="bk_pop" href="#hfpoik-tmp.REF.khumalo.2006.1057">Khumalo et al 2006</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.mercier.2013.1100">Mercier et al 2013</a>].</div></li></ul><p>Further studies are needed to confirm these preliminary <a class="def" href="/books/n/gene/glossary/def-item/genotype-phenotype-correlations/">genotype-phenotype correlations</a>.</p></div><div id="hfpoik-tmp.Penetrance"><h3>Penetrance</h3><p>To the authors' knowledge the <a class="def" href="/books/n/gene/glossary/def-item/penetrance/">penetrance</a> of POIKTMP is 100%, with occurrence of skin features in early childhood.</p></div><div id="hfpoik-tmp.Prevalence"><h3>Prevalence</h3><p>The prevalence of POIKTMP is unknown. The condition is thought to be ubiquitous and is likely underdiagnosed.</p></div></div><div id="hfpoik-tmp.Genetically_Related_Allelic_D"><h2 id="_hfpoik-tmp_Genetically_Related_Allelic_D_">Genetically Related (Allelic) Disorders</h2><p>No phenotypes other than those discussed in this <i>GeneReview</i> are known to be associated with pathogenic variants in <i>FAM111B</i>.</p></div><div id="hfpoik-tmp.Differential_Diagnosis"><h2 id="_hfpoik-tmp_Differential_Diagnosis_">Differential Diagnosis</h2><p>Disorders with phenotypic similarity to hereditary fibrosing poikiloderma with tendon contractures, myopathy, and pulmonary fibrosis (POIKTMP) are summarized in <a href="/books/NBK390610/table/hfpoik-tmp.T.genes_and_disorders_to_cons/?report=objectonly" target="object" rid-ob="figobhfpoiktmpTgenesanddisorderstocons">Table 2</a>. Notably, unlike POIKTMP, the disorders in <a href="/books/NBK390610/table/hfpoik-tmp.T.genes_and_disorders_to_cons/?report=objectonly" target="object" rid-ob="figobhfpoiktmpTgenesanddisorderstocons">Table 2</a> are not associated with muscle contractures, myopathy, or exocrine pancreatic insufficiency.</p><div id="hfpoik-tmp.T.genes_and_disorders_to_cons" class="table"><h3><span class="label">Table 2. </span></h3><div class="caption"><p>Genes and Disorders to Consider in the Differential Diagnosis of Hereditary Fibrosing Poikiloderma with Tendon Contractures, Myopathy, and Pulmonary Fibrosis</p></div><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK390610/table/hfpoik-tmp.T.genes_and_disorders_to_cons/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__hfpoik-tmp.T.genes_and_disorders_to_cons_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Gene(s)</th><th id="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Disorder</th><th id="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">MOI</th><th id="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Overlapping Features</th><th id="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_5" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Additional Distinguishing Features</th></tr></thead><tbody><tr><td headers="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<i>ANAPC1</i>
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<br />
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<i>RECQL4</i>
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||
</td><td headers="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"><a href="/books/n/gene/rts/">Rothmund Thomson syndrome</a> (RTS)</td><td headers="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">AR</td><td headers="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Early-onset poikiloderma, hypotrichosis, palmoplantar keratoderma</td><td headers="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">RTS is assoc w/skeletal & dental abnormalities.</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<i>FERMT1</i>
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</td><td headers="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<a href="/books/n/gene/kindler/">Kindler syndrome</a>
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</td><td headers="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">AR</td><td headers="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Diffuse poikiloderma w/striate & reticulate atrophy; widespread eczema-like dermatitis; keratotic papules of hands, feet, elbows, & knees; marked photosensitivity</td><td headers="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Kindler syndrome is assoc w/skin fragility w/bullae on extremities at birth & after minor trauma, webbing of fingers & toes, & esophageal & urethral strictures.</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<i>USB1</i>
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</td><td headers="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"><a href="/books/n/gene/poikiloderma-n/">Poikiloderma with neutropenia</a> (PN)</td><td headers="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">AR</td><td headers="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Early-onset poikiloderma & hematologic features</td><td headers="hd_h_hfpoik-tmp.T.genes_and_disorders_to_cons_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">PN is assoc w/distal-proximal limb & central body rash, hyperkeratotic nails, & recurrent infections. PN is not assoc w/photo- or heat sensitivity.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">AR = <a class="def" href="/books/n/gene/glossary/def-item/autosomal-recessive/">autosomal recessive</a>; MOI = <a class="def" href="/books/n/gene/glossary/def-item/mode-of-inheritance/">mode of inheritance</a></p></div></dd></dl></div></div></div><p><b>Hereditary sclerosing poikiloderma (HSP) of Weary</b> (OMIM <a href="https://omim.org/entry/173700" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">173700</a>), a disorder of unknown genetic cause, can also be considered in the differential diagnosis of POIKTMP. Like POIKTMP, HSP of Weary is associated with poikiloderma and sclerosis of palms and soles. Unlike POIKTMP, HSP of Weary is also known to be associated with linear sclerotic bands, subcutaneous calcifications, and valvular heart disease. HSP of Weary can be further distinguished from POIKTMP by the absence of muscle contractures, myopathy, and exocrine pancreatic insufficiency.</p></div><div id="hfpoik-tmp.Management"><h2 id="_hfpoik-tmp_Management_">Management</h2><div id="hfpoik-tmp.Evaluations_Following_Initial"><h3>Evaluations Following Initial Diagnosis</h3><p>To establish the extent of disease and needs in an individual diagnosed with hereditary fibrosing poikiloderma with tendon contractures, myopathy, and pulmonary fibrosis (POIKTMP), the evaluations summarized in <a href="/books/NBK390610/table/hfpoik-tmp.T.recommended_evaluations_fol/?report=objectonly" target="object" rid-ob="figobhfpoiktmpTrecommendedevaluationsfol">Table 3</a> (if not performed as part of the evaluation that led to the diagnosis) are recommended.</p><div id="hfpoik-tmp.T.recommended_evaluations_fol" class="table"><h3><span class="label">Table 3. </span></h3><div class="caption"><p>Recommended Evaluations Following Initial Diagnosis in Individuals with Hereditary Fibrosing Poikiloderma with Tendon Contractures, Myopathy, and Pulmonary Fibrosis</p></div><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK390610/table/hfpoik-tmp.T.recommended_evaluations_fol/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__hfpoik-tmp.T.recommended_evaluations_fol_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">System/Concern</th><th id="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Evaluation</th><th id="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Comment</th></tr></thead><tbody><tr><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<b>Skin</b>
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</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Dermatologic eval</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
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<b>Muscle</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">PT assessment</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Muscle MRI to evaluate for progressive muscle involvement is optional.</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Lung</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Eval by pulmonary specialists incl pulmonary function testing to evaluate for restrictive lung disease &/or pulmonary fibrosis</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Pancreas</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Fecal elastase level if steatorrhea is present</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Liver</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Serum transaminases (SGOT, SGPT), alkaline phosphatase, & gamma-glutamyl transferase</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Growth/</b>
|
||
<br />
|
||
<b>Nutrition</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Growth assessment for short stature &/or poor weight gain</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Hematologic</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Complete blood count w/differential</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Eye</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Ophthalmologic exam to evaluate for cataracts or other ocular abnormalities</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Genetic</b>
|
||
<br />
|
||
<b>counseling</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">By genetics professionals <sup>1</sup></td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">To inform patients & their families re nature, MOI, & implications of POIKTMP in order to facilitate medical & personal decision making</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Family support</b>
|
||
<br />
|
||
<b>& resources</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Assess:
|
||
<ul><li class="half_rhythm"><div>Use of community or <a href="#hfpoik-tmp.Resources">online resources</a> such as <a href="https://www.p2pusa.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Parent to Parent</a>;</div></li><li class="half_rhythm"><div>Need for social work involvement for parental support;</div></li><li class="half_rhythm"><div>Need for home nursing referral.</div></li></ul></td><td headers="hd_h_hfpoik-tmp.T.recommended_evaluations_fol_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">MOI = <a class="def" href="/books/n/gene/glossary/def-item/mode-of-inheritance/">mode of inheritance</a>; PT = physical therapy</p></div></dd><dt>1. </dt><dd><div id="hfpoik-tmp.TF.3.1"><p class="no_margin">Medical geneticist, certified genetic counselor, certified advanced genetic nurse</p></div></dd></dl></div></div></div></div><div id="hfpoik-tmp.Treatment_of_Manifestations"><h3>Treatment of Manifestations</h3><div id="hfpoik-tmp.T.treatment_of_manifestations" class="table"><h3><span class="label">Table 4. </span></h3><div class="caption"><p>Treatment of Manifestations in Individuals with Hereditary Fibrosing Poikiloderma with Tendon Contractures, Myopathy, and Pulmonary Fibrosis</p></div><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK390610/table/hfpoik-tmp.T.treatment_of_manifestations/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__hfpoik-tmp.T.treatment_of_manifestations_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Manifestation/<br />Concern</th><th id="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Treatment</th><th id="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Considerations/Other</th></tr></thead><tbody><tr><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_1" rowspan="2" scope="row" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Poikiloderma</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<ul><li class="half_rhythm"><div>Avoidance of excessive sun exposure</div></li><li class="half_rhythm"><div>Use of sunscreens w/both UVA & UVB protection</div></li></ul>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_2" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">Pulsed dye laser</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Can be discussed w/older patients for cosmetic management of telangiectatic component of the rash, but no data on its use are available.</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Hypohidrosis</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<ul><li class="half_rhythm"><div>Avoidance of excessive heat exposure</div></li><li class="half_rhythm"><div>Control of fever</div></li></ul>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Especially in 1st yrs of life to prevent overheating</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Lymphedema</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<ul><li class="half_rhythm"><div>Manual lymphatic drainage</div></li><li class="half_rhythm"><div>Compression</div></li></ul>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Eczema-like</b>
|
||
<br />
|
||
<b>lesions</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Topical treatment (e.g., emollients, topical steroids)</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Muscle</b>
|
||
<br />
|
||
<b>contractures</b>
|
||
<br />
|
||
<b>& weakness</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<ul><li class="half_rhythm"><div>PT & exercise to promote mobility & prevent contractures</div></li><li class="half_rhythm"><div>Calcium & vitamin D supplements may also be warranted in those w/muscle weakness to prevent osteopenia.</div></li></ul>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Lung disease</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<ul><li class="half_rhythm"><div>Use of self-inflating manual ventilation bag or mechanical insufflation-exsufflation device if needed</div></li><li class="half_rhythm"><div>Noninvasive ventilation if needed</div></li></ul>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Pancreatic</b>
|
||
<br />
|
||
<b>exocrine</b>
|
||
<br />
|
||
<b>insufficiency</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Pancreatic enzyme supplementation</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Liver</b>
|
||
<br />
|
||
<b>impairment</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Treatment of cholestasis w/ursodeoxycholic acid</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Growth/</b>
|
||
<br />
|
||
<b>Nutrition</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Food supplement or enteral feeding as needed for poor weight gain</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Cataract</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Surgical removal of visually significant cataracts</td><td headers="hd_h_hfpoik-tmp.T.treatment_of_manifestations_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">PT = physical therapy</p></div></dd></dl></div></div></div></div><div id="hfpoik-tmp.Surveillance"><h3>Surveillance</h3><div id="hfpoik-tmp.T.recommended_surveillance_fo" class="table"><h3><span class="label">Table 5. </span></h3><div class="caption"><p>Recommended Surveillance for Individuals with Hereditary Fibrosing Poikiloderma with Tendon Contractures, Myopathy, and Pulmonary Fibrosis</p></div><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK390610/table/hfpoik-tmp.T.recommended_surveillance_fo/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__hfpoik-tmp.T.recommended_surveillance_fo_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">System/Concern</th><th id="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Evaluation</th><th id="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Frequency</th></tr></thead><tbody><tr><td headers="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Dermatologic</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Dermatologic eval for poikiloderma, lymphedema of the limbs, eczema-like lesions, changes in nails & hair</td><td headers="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_3" rowspan="7" colspan="1" style="text-align:left;vertical-align:middle;">Annually &/or as needed</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Orthopedic</b>
|
||
<br />
|
||
<b>complications</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<ul><li class="half_rhythm"><div>PT assessment for muscle weakness or contractures</div></li><li class="half_rhythm"><div>Orthopedic eval for contractures (w/attn to Achilles tendon contractures) & scoliosis</div></li></ul>
|
||
</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Pulmonary disease</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Pulmonary function testing (FVC +/- chest CT scan w/DLCO)</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Liver dysfunction</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Serum transaminases (SGOT, SGPT), alkaline phosphatase, & gamma-glutamyl transferase</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Endocrine</b>
|
||
<br />
|
||
<b>complications</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<ul><li class="half_rhythm"><div>Blood ionogram (Na<sup>+</sup>, K<sup>+</sup>, Cl<sup>-</sup>HCO3<sup>-</sup>, Ca<sup>2+</sup>)</div></li><li class="half_rhythm"><div>TSH</div></li></ul>
|
||
</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Thrombocytopenia,</b>
|
||
<br />
|
||
<b>eosinophilia</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Complete blood count w/differential</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Cataract</b>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.recommended_surveillance_fo_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Ophthalmologic exam</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">DLCO = diffusing capacity of the lungs for carbon monoxide; FVC = forced vital capacity; PT = physical therapy</p></div></dd></dl></div></div></div></div><div id="hfpoik-tmp.AgentsCircumstances_to_Avoid"><h3>Agents/Circumstances to Avoid</h3><p>Avoid the following:</p><ul><li class="half_rhythm"><div>Excessive sun exposure, which may exacerbate the rash</div></li><li class="half_rhythm"><div>Exposure to heat because of heat intolerance secondary to hypohidrosis</div></li></ul></div><div id="hfpoik-tmp.Evaluation_of_Relatives_at_Ri"><h3>Evaluation of Relatives at Risk</h3><p>See <a href="#hfpoik-tmp.Related_Genetic_Counseling_Is">Genetic Counseling</a> for issues related to testing of at-risk relatives for <a class="def" href="/books/n/gene/glossary/def-item/genetic-counseling/">genetic counseling</a> purposes.</p></div><div id="hfpoik-tmp.Therapies_Under_Investigation"><h3>Therapies Under Investigation</h3><p>Search <a href="https://clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov</a> in the US and <a href="https://www.clinicaltrialsregister.eu/ctr-search/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">EU Clinical Trials Register</a> in Europe for access to information on clinical studies for a wide range of diseases and conditions.</p></div></div><div id="hfpoik-tmp.Genetic_Counseling"><h2 id="_hfpoik-tmp_Genetic_Counseling_">Genetic Counseling</h2><p>
|
||
<i>Genetic counseling is the process of providing individuals and families with
|
||
information on the nature, mode(s) of inheritance, and implications of genetic disorders to help them
|
||
make informed medical and personal decisions. The following section deals with genetic
|
||
risk assessment and the use of family history and genetic testing to clarify genetic
|
||
status for family members; it is not meant to address all personal, cultural, or
|
||
ethical issues that may arise or to substitute for consultation with a genetics
|
||
professional</i>. —ED.</p><div id="hfpoik-tmp.Mode_of_Inheritance"><h3>Mode of Inheritance</h3><p>Hereditary fibrosing poikiloderma with tendon contractures, myopathy, and pulmonary fibrosis (POIKTMP) is inherited in an <a class="def" href="/books/n/gene/glossary/def-item/autosomal-dominant/">autosomal dominant</a> manner.</p></div><div id="hfpoik-tmp.Risk_to_Family_Members"><h3>Risk to Family Members</h3><p>
|
||
<b>Parents of a <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a></b>
|
||
</p><ul><li class="half_rhythm"><div>Approximately 50% of individuals diagnosed with POIKTMP have an affected parent.</div></li><li class="half_rhythm"><div>Approximately 50% of individuals diagnosed with POIKTMP have the disorder as the result of a <i>de novo FAM111B</i> <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a>.</div></li><li class="half_rhythm"><div>If the <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a> appears to be the only affected family member (i.e., a <a class="def" href="/books/n/gene/glossary/def-item/simplex/">simplex</a> case), <a class="def" href="/books/n/gene/glossary/def-item/molecular-genetic-testing/">molecular genetic testing</a> is recommended for the parents of the proband to confirm their genetic status and to allow reliable <a class="def" href="/books/n/gene/glossary/def-item/recurrence-risk/">recurrence risk</a> counseling.</div></li><li class="half_rhythm"><div>If the <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a> identified in the <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a> is not identified in either parent and parental identity testing has confirmed biological maternity and paternity, the following possibilities should be considered:</div><ul><li class="half_rhythm"><div>The <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a> has a <a class="def" href="/books/n/gene/glossary/def-item/de-novo/"><i>de novo</i></a> <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a>.</div></li><li class="half_rhythm"><div>The <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a> inherited a <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a> from a parent with <a class="def" href="/books/n/gene/glossary/def-item/germline/">germline</a> (or somatic and germline) <a class="def" href="/books/n/gene/glossary/def-item/mosaicism/">mosaicism</a>. Note: Testing of parental leukocyte DNA may not detect all instances of <a class="def" href="/books/n/gene/glossary/def-item/somatic-mosaicism/">somatic mosaicism</a> and will not detect a pathogenic variant that is present in the germ cells only.</div></li></ul></li></ul><p><b>Sibs of a <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a>.</b> The risk to the sibs of the proband depends on the genetic status of the proband’s parents:</p><ul><li class="half_rhythm"><div>If a parent of the <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a> is affected and/or is known to have the <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a> identified in the proband, the risk to the sibs of inheriting the pathogenic variant is 50%. Although all sibs who inherit a <i>FAM111B</i> pathogenic variant are expected to develop manifestations of the disorder, intrafamilial clinical variability has been observed (see <a href="#hfpoik-tmp.Clinical_Description">Clinical Description</a>).</div></li><li class="half_rhythm"><div>If the <i>FAM111B</i> <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a> detected in the <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a> cannot be detected in the leukocyte DNA of either parent, the <a class="def" href="/books/n/gene/glossary/def-item/recurrence-risk/">recurrence risk</a> to sibs is estimated to be 1% because of the theoretic possibility of parental <a class="def" href="/books/n/gene/glossary/def-item/germline-mosaicism/">germline mosaicism</a> [<a class="bk_pop" href="#hfpoik-tmp.REF.rahbari.2016.126">Rahbari et al 2016</a>].</div></li><li class="half_rhythm"><div>If the parents have not been tested for the <i>FAM111B</i> <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a> but are clinically unaffected, the risk to the sibs of a <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a> appears to be low. However, sibs of a proband with clinically unaffected parents are still presumed to be at increased risk for POIKTMP because of the theoretic possibility of parental <a class="def" href="/books/n/gene/glossary/def-item/germline-mosaicism/">germline mosaicism</a>.</div></li></ul><p><b>Offspring of a <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a>.</b> Each child of an individual with POIKTMP has a 50% chance of inheriting the <i>FAM111B</i> <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a>.</p><p><b>Other family members.</b> The risk to other family members depends on the status of the <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a>'s parents: if a parent has the <i>FAM111B</i> <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a>, his or her family members may be at risk.</p></div><div id="hfpoik-tmp.Related_Genetic_Counseling_Is"><h3>Related Genetic Counseling Issues</h3><p>
|
||
<b>Family planning</b>
|
||
</p><ul><li class="half_rhythm"><div>The optimal time for determination of genetic risk and discussion of the availability of prenatal/<a class="def" href="/books/n/gene/glossary/def-item/preimplantation-genetic-testing/">preimplantation genetic testing</a> is before pregnancy.</div></li><li class="half_rhythm"><div>It is appropriate to offer <a class="def" href="/books/n/gene/glossary/def-item/genetic-counseling/">genetic counseling</a> (including discussion of potential risks to offspring and reproductive options) to young adults who are affected or at risk.</div></li></ul></div><div id="hfpoik-tmp.Prenatal_Testing_and_Preimpla"><h3>Prenatal Testing and Preimplantation Genetic Testing</h3><p>Once the <i>FAM111B</i> <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a> has been identified in an affected family member, prenatal and <a class="def" href="/books/n/gene/glossary/def-item/preimplantation-genetic-testing/">preimplantation genetic testing</a> are possible.</p><p>Differences in perspective may exist among medical professionals and within families regarding the use of <a class="def" href="/books/n/gene/glossary/def-item/prenatal-testing/">prenatal testing</a>. While most centers would consider use of prenatal testing to be a personal decision, discussion of these issues may be helpful.</p></div></div><div id="hfpoik-tmp.Resources"><h2 id="_hfpoik-tmp_Resources_">Resources</h2><p>
|
||
<i>GeneReviews staff has selected the following disease-specific and/or umbrella
|
||
support organizations and/or registries for the benefit of individuals with this disorder
|
||
and their families. GeneReviews is not responsible for the information provided by other
|
||
organizations. For information on selection criteria, click <a href="/books/n/gene/app4/">here</a>.</i></p>
|
||
<ul><li class="half_rhythm"><div>
|
||
<b>MedlinePlus</b>
|
||
</div><div>
|
||
<a href="https://medlineplus.gov/genetics/condition/hereditary-fibrosing-poikiloderma-with-tendon-contractures-myopathy-and-pulmonary-fibrosis/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Hereditary fibrosing poikiloderma with tendon contractures, myopathy, and pulmonary fibrosis</a>
|
||
</div></li></ul>
|
||
</div><div id="hfpoik-tmp.Molecular_Genetics"><h2 id="_hfpoik-tmp_Molecular_Genetics_">Molecular Genetics</h2><p><i>Information in the Molecular Genetics and OMIM tables may differ from that elsewhere in the GeneReview: tables may contain more recent information. —</i>ED.</p><div id="hfpoik-tmp.molgen.TA" class="table"><h3><span class="label">Table A.</span></h3><div class="caption"><p>Hereditary Fibrosing Poikiloderma with Tendon Contractures, Myopathy, and Pulmonary Fibrosis: Genes and Databases</p></div><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK390610/table/hfpoik-tmp.molgen.TA/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__hfpoik-tmp.molgen.TA_lrgtbl__"><table class="no_bottom_margin"><tbody><tr><th id="hd_b_hfpoik-tmp.molgen.TA_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Gene</th><th id="hd_b_hfpoik-tmp.molgen.TA_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">Chromosome Locus</th><th id="hd_b_hfpoik-tmp.molgen.TA_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">Protein</th><th id="hd_b_hfpoik-tmp.molgen.TA_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">HGMD</th><th id="hd_b_hfpoik-tmp.molgen.TA_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">ClinVar</th></tr><tr><td headers="hd_b_hfpoik-tmp.molgen.TA_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">
|
||
<a href="/gene/374393" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=gene">
|
||
<i>FAM111B</i>
|
||
</a>
|
||
</td><td headers="hd_b_hfpoik-tmp.molgen.TA_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">
|
||
<a href="https://www.ncbi.nlm.nih.gov/genome/gdv/?context=gene&acc=374393" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">11q12<wbr style="display:inline-block"></wbr>.1</a>
|
||
</td><td headers="hd_b_hfpoik-tmp.molgen.TA_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">
|
||
<a href="http://www.uniprot.org/uniprot/Q6SJ93" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Serine protease FAM111B</a>
|
||
</td><td headers="hd_b_hfpoik-tmp.molgen.TA_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">
|
||
<a href="http://www.hgmd.cf.ac.uk/ac/gene.php?gene=FAM111B" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">FAM111B</a>
|
||
</td><td headers="hd_b_hfpoik-tmp.molgen.TA_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">
|
||
<a href="https://www.ncbi.nlm.nih.gov/clinvar/?term=FAM111B[gene]" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">FAM111B</a>
|
||
</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div id="hfpoik-tmp.TFA.1"><p class="no_margin">Data are compiled from the following standard references: <a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a> from
|
||
<a href="http://www.genenames.org/index.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">HGNC</a>;
|
||
<a class="def" href="/books/n/gene/glossary/def-item/chromosome/">chromosome</a> <a class="def" href="/books/n/gene/glossary/def-item/locus/">locus</a> from
|
||
<a href="http://www.omim.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">OMIM</a>;
|
||
protein from <a href="http://www.uniprot.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">UniProt</a>.
|
||
For a description of databases (Locus Specific, HGMD, ClinVar) to which links are provided, click
|
||
<a href="/books/n/gene/app1/">here</a>.</p></div></dd></dl></div></div></div><div id="hfpoik-tmp.molgen.TB" class="table"><h3><span class="label">Table B.</span></h3><div class="caption"><p>OMIM Entries for Hereditary Fibrosing Poikiloderma with Tendon Contractures, Myopathy, and Pulmonary Fibrosis (<a href="/omim/615584,615704" ref="pagearea=body&targetsite=entrez&targetcat=term&targettype=omim">View All in OMIM</a>) </p></div><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK390610/table/hfpoik-tmp.molgen.TB/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__hfpoik-tmp.molgen.TB_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<a href="/omim/615584" ref="pagearea=body&targetsite=entrez&targetcat=term&targettype=omim">615584</a></td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">FAMILY WITH SEQUENCE SIMILARITY 111, MEMBER B; FAM111B</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<a href="/omim/615704" ref="pagearea=body&targetsite=entrez&targetcat=term&targettype=omim">615704</a></td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">POIKILODERMA, HEREDITARY FIBROSING, WITH TENDON CONTRACTURES, MYOPATHY, AND PULMONARY FIBROSIS; POIKTMP</td></tr></tbody></table></div></div><div id="hfpoik-tmp.Molecular_Pathogenesis"><h3>Molecular Pathogenesis</h3><p>The FAM111B protein is predicted to contain a trypsin-like cysteine/serine peptidase <a class="def" href="/books/n/gene/glossary/def-item/domain/">domain</a>. A role in DNA replication is suggested [<a class="bk_pop" href="#hfpoik-tmp.REF.aviner.2015.e1005554">Aviner et al 2015</a>].</p><p>Hereditary fibrosing poikiloderma with tendon contractures, myopathy, and pulmonary fibrosis (POIKTMP) is most frequently caused by heterozygosity for <a class="def" href="/books/n/gene/glossary/def-item/missense/">missense</a> <i>FAM111B</i> pathogenic variants in the predicted trypsin-like cysteine/serine peptidase <a class="def" href="/books/n/gene/glossary/def-item/domain/">domain</a> of the protein, in particular in the loop of the functional domain.</p><p><b>Mechanism of disease causation.</b> The mechanism of disease for POIKTMP is not known; however, the spectrum of pathogenic variants and functional studies suggest a <a class="def" href="/books/n/gene/glossary/def-item/dominant-negative/">dominant-negative</a> mechanism [<a class="bk_pop" href="#hfpoik-tmp.REF.mercier.2015.135">Mercier et al 2015</a>; Author, unpublished data].</p><div id="hfpoik-tmp.T.notable_fam111b_pathogenic" class="table"><h3><span class="label">Table 6. </span></h3><div class="caption"><p>Notable <i>FAM111B</i> Pathogenic Variants</p></div><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK390610/table/hfpoik-tmp.T.notable_fam111b_pathogenic/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__hfpoik-tmp.T.notable_fam111b_pathogenic_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reference Sequences</th><th id="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">DNA Nucleotide Change</th><th id="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Predicted Protein Change</th><th id="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Comment [Reference]</th></tr></thead><tbody><tr><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_1" rowspan="9" scope="row" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<a href="https://www.ncbi.nlm.nih.gov/nuccore/NM_198947.3" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NM_198947<wbr style="display:inline-block"></wbr>.3</a>
|
||
<br />
|
||
<a href="https://www.ncbi.nlm.nih.gov/protein/NP_945185.1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NP_945185<wbr style="display:inline-block"></wbr>.1</a>
|
||
</td><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">c.1261_1263delAAG</td><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">p.Lys421del</td><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_4" rowspan="4" colspan="1" style="text-align:left;vertical-align:middle;">May be assoc w/less severe extracutaneous <a class="def" href="/books/n/gene/glossary/def-item/phenotype/">phenotype</a> [<a class="bk_pop" href="#hfpoik-tmp.REF.khumalo.2006.1057">Khumalo et al 2006</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.mercier.2013.1100">Mercier et al 2013</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.mercier.2015.135">Mercier et al 2015</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.seo.2016.858">Seo et al 2016</a>, <a class="bk_pop" href="#hfpoik-tmp.REF.takeichi.2017.534">Takeichi et al 2017</a>]. Further studies are needed.</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_2" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">c.1247T>C</td><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">p.Phe416Ser</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_2" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">c.1289A>C</td><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">p.Gln430Pro</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_2" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">c.1861T>G</td><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">p.Tyr621Asp</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_2" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">c.1874C>A</td><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">p.Thr625Asn</td><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_4" rowspan="5" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_2" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">c.1879A>G</td><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">p.Arg627Gly</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_2" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">c.1881A>T</td><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">p.Arg627Ser</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_2" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">c.1883G>A</td><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">p.Ser628Asn</td></tr><tr><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_2" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">c.1884T>A</td><td headers="hd_h_hfpoik-tmp.T.notable_fam111b_pathogenic_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">p.Ser628Asn</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">Variants listed in the table have been provided by the authors. GeneReviews staff have not independently verified the classification of variants.</p></div></dd><dt></dt><dd><div><p class="no_margin">GeneReviews follows the standard naming conventions of the Human Genome Variation Society (<a href="https://varnomen.hgvs.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">varnomen<wbr style="display:inline-block"></wbr>.hgvs.org</a>). See <a href="/books/n/gene/app3/">Quick Reference</a> for an explanation of nomenclature.</p></div></dd></dl></div></div></div></div></div><div id="hfpoik-tmp.Chapter_Notes"><h2 id="_hfpoik-tmp_Chapter_Notes_">Chapter Notes</h2><div id="hfpoik-tmp.Author_Notes"><h3>Author Notes</h3><p>Areas of interest/inquiry:</p><ul><li class="half_rhythm"><div>Prof Sandra Mercier, MD, PhD, clinician geneticist; Dr Sébastien Barbarot, MD, PhD, dermatologist: diagnosis and clinical follow up of patients with POIKTMP</div></li><li class="half_rhythm"><div>Sébastien Küry, DVM, PhD: <i>FAM111B</i> molecular diagnosis</div></li></ul><p>Prof Sandra Mercier and Dr Sébastien Küry are part of the Inserm UMR 1087 / CNRS UMR 6291 research team where functional studies are underway to understand the pathophysiology of the disease and find therapeutic approaches.</p><p>Contact: sandra.mercier@chu-nantes.fr</p></div><div id="hfpoik-tmp.Acknowledgments"><h3>Acknowledgments</h3><p>We thank the families and patients for their cooperation and support.</p></div><div id="hfpoik-tmp.Revision_History"><h3>Revision History</h3><ul><li class="half_rhythm"><div>9 September 2021 (sm) Revision: nucleotide variant correction: c.1881A>T</div></li><li class="half_rhythm"><div>5 August 2021 (sw) Comprehensive update posted live</div></li><li class="half_rhythm"><div>13 October 2016 (bp) Review posted live</div></li><li class="half_rhythm"><div>1 February 2016 (sm) Original submission</div></li></ul></div></div><div id="hfpoik-tmp.References"><h2 id="_hfpoik-tmp_References_">References</h2><div id="hfpoik-tmp.Literature_Cited"><h3>Literature Cited</h3><ul class="simple-list"><li class="half_rhythm"><div class="bk_ref" id="hfpoik-tmp.REF.aviner.2015.e1005554">Aviner R, Shenoy A, Elroy-Stein O, Geiger T. Uncovering hidden layers of cell cycle regulation through integrative multi-omic analysis. <span><span class="ref-journal">PLoS Genet. </span>2015;<span class="ref-vol">11</span>:e1005554. </span> [<a href="/pmc/articles/PMC4595013/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4595013</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26439921" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26439921</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="hfpoik-tmp.REF.chasseuil.2019.862">Chasseuil E, McGrath JA, Seo A, Balguerie X, Bodak N, Chasseuil H, Denis-Musquer M, Goldenberg A, Goussot R, Irvine AD, Khumalo NP, King MC, Küry S, Lipsker D, Mallet S, Mayosi BM, Nanda A, Puzenat E, Salort-Campana E, Sidbury R, Shimamura A, Bézieau S, Mercier S, Barbarot S. Dermatological manifestations of hereditary fibrosing poikiloderma with tendon contractures, myopathy and pulmonary fibrosis (POIKTMP): a case series of 28 patients. <span><span class="ref-journal">Br J Dermatol. </span>2019;<span class="ref-vol">181</span>:862–4.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30972747" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30972747</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="hfpoik-tmp.REF.chen.2019.695">Chen F, Zheng L, Li Y, Li H, Yao Z, Li M. Mutation in FAM111B causes hereditary fibrosing poikiloderma with tendon contracture, myopathy, and pulmonary fibrosis. <span><span class="ref-journal">Acta Derm Venereol. </span>2019;<span class="ref-vol">99</span>:695–6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30938824" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30938824</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="hfpoik-tmp.REF.dokic.2020.1217">Dokic Y, Albahrani Y, Phung T, Patel K, de Guzman M, Hertel P, Hunt R. Hereditary fibrosing poikiloderma with tendon contractures, myopathy, and pulmonary fibrosis: Hepatic disease in a child with a novel pathogenic variant of FAM111B. <span><span class="ref-journal">JAAD Case Rep. </span>2020;<span class="ref-vol">6</span>:1217–20.</span> [<a href="/pmc/articles/PMC7701006/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7701006</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33294546" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33294546</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="hfpoik-tmp.REF.goussot.2017.143">Goussot R, Prasad M, Stoetzel C, Lenormand C, Dollfus H, Lipsker D. Expanding phenotype of hereditary fibrosing poikiloderma with tendon contractures, myopathy, and pulmonary fibrosis caused by FAM111B mutations: Report of an additional family raising the question of cancer predisposition and a short review of early-onset poikiloderma. <span><span class="ref-journal">JAAD Case Rep. </span>2017;<span class="ref-vol">3</span>:143–50.</span> [<a href="/pmc/articles/PMC5358901/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5358901</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28349113" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28349113</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="hfpoik-tmp.REF.kazlouskaya.2018.e443">Kazlouskaya V, Feldman EJ, Jakus J, Heilman E, Glick S. A case of hereditary fibrosing poikiloderma with tendon contractures, myopathy and pulmonary fibrosis (POIKTMP) with the emphasis on cutaneous histopathological findings. <span><span class="ref-journal">J Eur Acad Dermatol Venereol. </span>2018;<span class="ref-vol">32</span>:e443–e445.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29578632" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29578632</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="hfpoik-tmp.REF.khumalo.2006.1057">Khumalo NP, Pillay K, Beighton P, Wainwright H, Walker B, Saxe N, Mayosi BM, Bateman ED. Poikiloderma, tendon contracture and pulmonary fibrosis: a new autosomal dominant syndrome? <span><span class="ref-journal">Br J Dermatol. </span>2006;<span class="ref-vol">155</span>:1057–61.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17034542" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17034542</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="hfpoik-tmp.REF.mercier.2015.135">Mercier S, Küry S, Salort-Campana E, Magot A, Agbim U, Besnard T, Bodak N, Bou-Hanna C, Breheret F, Brunelle P, Caillon F, Chabrol B, Cormier-Daire V, David A, Eymard B, Faivre L, Figarella-Branger D, Fleurence E, Ganapathi M, Gherardi R, Goldenberg A, Hamel A, Igual J, Irvine AD, Israel-Biet D, Kannengiesser C, Laboisse C, Le Caignec C, Mahe JY, Mallet S, MacGowan S, McAleer MA, McLean I, Meni C, Munnich A, Mussini JM, Nagy PL, Odel J, O'Regan GM, Pereon Y, Perrier J, Piard J, Puzenat E, Sampson JB, Smith F, Soufir N, Tanji K, Thauvin C, Ulane C, Watson RM, Khumalo NP, Mayosi BM, Barbarot S, Bezieau S. Expanding the clinical spectrum of hereditary fibrosing poikiloderma with tendon contractures, myopathy and pulmonary fibrosis due to FAM111B mutations. <span><span class="ref-journal">Orphanet J Rare Dis. </span>2015;<span class="ref-vol">10</span>:135.</span> [<a href="/pmc/articles/PMC4608180/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4608180</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26471370" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26471370</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="hfpoik-tmp.REF.mercier.2013.1100">Mercier S, Küry S, Shaboodien G, Houniet DT, Khumalo NP, Bou-Hanna C, Bodak N, Cormier-Daire V, David A, Faivre L, Figarella-Branger D, Gherardi RK, Glen E, Hamel A, Laboisse C, Le Caignec C, Lindenbaum P, Magot A, Munnich A, Mussini JM, Pillay K, Rahman T, Redon R, Salort-Campana E, Santibanez-Koref M, Thauvin C, Barbarot S, Keavney B, Bézieau S, Mayosi BM. Mutations in FAM111B cause hereditary fibrosing poikiloderma with tendon contracture, myopathy, and pulmonary fibrosis. <span><span class="ref-journal">Am J Hum Genet. </span>2013;<span class="ref-vol">93</span>:1100–7.</span> [<a href="/pmc/articles/PMC3853004/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3853004</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24268661" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24268661</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="hfpoik-tmp.REF.rahbari.2016.126">Rahbari R, Wuster A, Lindsay SJ, Hardwick RJ, Alexandrov LB, Turki SA, Dominiczak A, Morris A, Porteous D, Smith B, Stratton MR, Hurles ME, et al. Timing, rates and spectra of human germline mutation. <span><span class="ref-journal">Nat Genet. </span>2016;<span class="ref-vol">48</span>:126–33.</span> [<a href="/pmc/articles/PMC4731925/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4731925</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26656846" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26656846</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="hfpoik-tmp.REF.seo.2016.858">Seo A, Walsh T, Lee MK, Ho PA, Hsu EK, Sidbury R, King MC, Shimamura A. FAM111B mutation is associated with inherited exocrine pancreatic dysfunction. <span><span class="ref-journal">Pancreas. </span>2016;<span class="ref-vol">45</span>:858–62.</span> [<a href="/pmc/articles/PMC4841754/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4841754</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26495788" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26495788</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="hfpoik-tmp.REF.takeichi.2017.534">Takeichi T, Nanda A, Yang HS, Hsu CK, Lee JY, Al-Ajmi H, Akiyama M, Simpson MA, McGrath JA. Syndromic inherited poikiloderma due to a de novo mutation in FAM111B. <span><span class="ref-journal">Br J Dermatol. </span>2017;<span class="ref-vol">176</span>:534–6.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27406236" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27406236</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="hfpoik-tmp.REF.zhang.2019.1014">Zhang Z, Zhang J, Chen F, Zheng L, Li H, Liu M, Li M, Yao Z. Family of hereditary fibrosing poikiloderma with tendon contractures, myopathy and pulmonary fibrosis caused by a novel FAM111B mutation. <span><span class="ref-journal">J Dermatol. </span>2019;<span class="ref-vol">46</span>:1014–8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/31392773" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31392773</span></a>]</div></li></ul></div></div><div id="bk_toc_contnr"></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK390610/?report=reader">PubReader</a></li><li><a href="/books/NBK390610/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK390610" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK390610" style="display:none" title="Cite this Page"><div class="bk_tt">Mercier S, Küry S, Barbarot S. Hereditary Fibrosing Poikiloderma with Tendon Contractures, Myopathy, and Pulmonary Fibrosis. 2016 Oct 13 [Updated 2021 Sep 9]. In: Adam MP, Feldman J, Mirzaa GM, et al., editors. GeneReviews® [Internet]. 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xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> FBN1-Related Marfan Syndrome.</a><span class="source">[GeneReviews(®). 1993]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> FBN1-Related Marfan Syndrome.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Dietz H. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">GeneReviews(®). 1993</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/20301490" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Calpainopathy.</a><span class="source">[GeneReviews(®). 1993]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Calpainopathy.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Angelini C. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">GeneReviews(®). 1993</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/20301551" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Sickle Cell Disease.</a><span class="source">[GeneReviews(®). 1993]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Sickle Cell Disease.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Bender MA, Carlberg K. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">GeneReviews(®). 1993</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/20301468" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Congenital Muscular Dystrophy Overview – RETIRED CHAPTER, FOR HISTORICAL REFERENCE ONLY.</a><span class="source">[GeneReviews(®). 1993]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Congenital Muscular Dystrophy Overview – RETIRED CHAPTER, FOR HISTORICAL REFERENCE ONLY.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Sparks SE, Quijano-Roy S, Harper A, Rutkowski A, Gordon E, Hoffman EP, Pegoraro E. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">GeneReviews(®). 1993</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/20301668" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Hemophilia B.</a><span class="source">[GeneReviews(®). 1993]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Hemophilia B.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">Konkle BA, Nakaya Fletcher S. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">GeneReviews(®). 1993</em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=27748098" ref="ordinalpos=1&log$=relatedreviews_seeall&logdbfrom=pubmed">See reviews...</a><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=27748098" ref="ordinalpos=1&log$=relatedarticles_seeall&logdbfrom=pubmed">See all...</a></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Recent Activity</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="recent_activity" id="Shutter"></a></div><div class="portlet_content"><div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="HTDisplay" class=""><div class="action"><a href="javascript:historyDisplayState('ClearHT')">Clear</a><a href="javascript:historyDisplayState('HTOff')" class="HTOn">Turn Off</a><a href="javascript:historyDisplayState('HTOn')" class="HTOff">Turn On</a></div><ul id="activity"><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=1" href="/portal/utils/pageresolver.fcgi?recordid=67d438adcde49f3df7ea5134">Hereditary Fibrosing Poikiloderma with Tendon Contractures, Myopathy, and Pulmon...</a><div class="ralinkpop offscreen_noflow">Hereditary Fibrosing Poikiloderma with Tendon Contractures, Myopathy, and Pulmonary Fibrosis - GeneReviews®<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=2" href="/portal/utils/pageresolver.fcgi?recordid=67d438accde49f3df7ea490a">Table 6. [Notable FAM111B Pathogenic Variants]. - GeneReviews®</a><div class="ralinkpop offscreen_noflow">Table 6. [Notable FAM111B Pathogenic Variants]. - GeneReviews®<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=3" href="/portal/utils/pageresolver.fcgi?recordid=67d438ab67c23b31e0c96fce">Table B. [OMIM Entries for Hereditary Fibrosing...]. - GeneReviews®</a><div class="ralinkpop offscreen_noflow">Table B. [OMIM Entries for Hereditary Fibrosing...]. - GeneReviews®<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=4" href="/portal/utils/pageresolver.fcgi?recordid=67d43890cde49f3df7e99a0e">RecName: Full=Serine protease FAM111B; AltName: Full=Cancer-associated nucleopro...</a><div class="ralinkpop offscreen_noflow">RecName: Full=Serine protease FAM111B; AltName: Full=Cancer-associated nucleoprotein<div class="brieflinkpopdesc">gi|74758524|sp|Q6SJ93.1|F111B_HUMAN</div></div><div class="tertiary">Protein</div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=5" href="/portal/utils/pageresolver.fcgi?recordid=67d438822f30673f7b0e6e04">Hereditary sclerosing poikiloderma with tendon and pulmonary involvement</a><div class="ralinkpop offscreen_noflow">Hereditary sclerosing poikiloderma with tendon and pulmonary involvement<div class="brieflinkpopdesc"></div></div><div class="tertiary">MedGen</div></li></ul><p class="HTOn">Your browsing activity is empty.</p><p class="HTOff">Activity recording is turned off.</p><p id="turnOn" class="HTOff"><a href="javascript:historyDisplayState('HTOn')">Turn recording back on</a></p><a class="seemore" href="/sites/myncbi/recentactivity">See more...</a></div></div></div>
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