Pyloric atresia is a rare but serious condition that can occur with junctional epidermolysis bullosa (PA-JEB). Early recognition is necessary for timely intervention, but prognosis can be serious and mortality is high.
Objective:
We describe the case of a patient with PA-JEB who not only survived past infancy, but showed improvement in cutaneous blistering as she grew older.
Conclusion:
With early surgical intervention, some patients with PA-JEB can survive and look forward to a favourable prognosis, with improvement of cutaneous blistering by early childhood.
Get full access to this article
View all access options for this article.
References
1.
PulkkinenLKimDUUittoJ. Epidermolysis bullosa with pyloric atresia: Novel mutations in the beta-4 integrin gene (ITGB4). Am J Pathol1998; 152:157–166.
2.
ShawDWFineJ-DPiacquadioDJ. Gastric outlet obstruction and epidermolysis bullosa. J Am Acad Dermatol1997; 36:304–310.
3.
LestringantGGAkelSRQayedKI. The pyloric atresia-junctional epidermolysis bullosa syndrome: Report of a case and review of the literature. Arch Dermatol1992; 128:1083–1086.
4.
BullMJNorinsALWeaverDD. Epidermolysis bullosa—pyloric atresia: An autosomal recessive syndrome. Am J Dis Child1983; 137:449–451.
5.
PulkkinenLKimonisVEXuY. Homozygous alpha-6 integrin mutation in junctional epidermolysis bullosa with congenital duodenal atresia. Hum Mol Genet1997; 6:669–674.
6.
ZirnJScottRAronianJM. Gastric outlet obstruction and gastric infarct in junctional epidermolysis bullosa. Pediatr Dermatol1995; 12:174–177.
7.
RuzziLGagnoux-PalaciosLPinolaM. A homozygous mutation in the integrin alpha-6 gene in junctional epidermolysis bullosa with pyloric atresia. J Clin Invest1997; 99:2826–2831.
8.
CetinkursunSOzturkHCelasunB. Epidermolysis bullosa associated with pyloric, esophageal, and anal atresia: A case report. J Pediatr Surg1995; 30:1477–1478.
9.
ReitelmanCBurbigeKAMitchellM. The urological manifestations of epidermolysis bullosa. J Urology1986; 136:1320–1322.
AchironRHamiel-PinchasOEngelbergS. Aplasia cutis congenita associated with epidermolysis bullosa and pyloric atresia: The diagnostic role of prenatal ultrasonography. Prenat Diagn1992; 12:765–771.
13.
DolanCRSmithLTSybertVP. Prenatal detection of epidermolysis bullosa letalis with pyloric atresia in a fetus by abnormal ultrasound and elevated alpha-fetoprotein. Am J Med Genet1993; 47:395–400.
14.
NesinMSeymourCKimY. Role of elevated alpha-fetoprotein in prenatal diagnosis of junctional epidermolysis bullosa and pyloric atresia. Am J Perinatol1994; 11:286–287.
15.
PulkkinenLBruckner-TudermanLAugustC. Compound heterozygosity for missense (L156P) and nonsense (R554X) mutations in the beta 4 integrin gene (ITGB4) underlies mild, non-lethal phenotype of epidermolysis bullosa with pyloric atresia. Am J Pathol1998; 152:935–941.
16.
FonkalsrudEWde LorimierAAHaysDM. Congenital atresia and stenosis of the duodenum: A review compiled from the members of the surgical section of the American Academy of Pediatrics. Pediatr1969; 43:79–83.
17.
BestLGWisemanNEChudleyAE. Familial duodenal atresia: A report of two families and review. Am J Med Genet1989; 34:442–444.
18.
CowtonJALBeattieTJGibsonAAM. Epidermolysis bullosa in association with aplasia cutis congenita and pyloric atresia. Acta Paediatr Scand1982; 71:155–160.
19.
PuvabanditsinSGarrowESumransamraujkitR. Epidermolysis bullosa associated with congenital localized absence of skin, fetal abdominal mass, and pyloric atresia. Pediatr Dermatol1997; 14:359–362.
20.
LinAN. Pyloric atresia and epidermolysis bullosa. Pediatr Dermatol1997; 14:406–408.
21.
PedersenPVHertelJ. Pyloric atresia in epidermolysis bullosa. J Pediatr1977; 91:852–853.
22.
KorberJSGlassonMJ. Pyloric atresia associated with epidermolysis bullosa. J Pediatr1977; 90:600–601.
UittoJPulkkinenL. Molecular complexity of the cutaneous basement membrane zone. Mol Biol Rep1996; 23:35–46.
27.
UittoJPulkkinenLSmithFJD. Plectin and human genetic disorders of the skin and muscle: The paradigm of epidermolysis bullosa with muscular dystrophy. Exp Dermatol1996; 5:237–246.