Article Text
Abstract
Background EPHB4 loss of function is associated with type 2 capillary malformation–arteriovenous malformation syndrome, an autosomal dominant vascular disorder. The phenotype partially overlaps with hereditary haemorrhagic telangiectasia (HHT) due to epistaxis, telangiectases and cerebral arteriovenous malformations, but a similar liver involvement has never been described.
Methods Members of the French HHT network reported their cases of EPHB4 mutation identified after an initial suspicion of HHT. Clinical, radiological and genetic characteristics were analysed.
Results Among 21 patients with EPHB4, 15 had a liver imaging, including 7 with HHT-like abnormalities (2 female patients and 5 male patients, ages 43–69 years). Atypical epistaxis and telangiectases were noted in two cases each. They were significantly older than the eight patients with normal imaging (median: 51 vs 20 years, p<0.0006).
The main hepatic artery was dilated in all the cases (diameter: 8–11 mm). Six patients had hepatic telangiectases. All kind of shunts were described (arteriosystemic: five patients, arterioportal: two patients, portosystemic: three patients). The overall liver appearance was considered as typical of HHT in six cases.
Six EPHB4 variants were classified as pathogenic and one as likely pathogenic, with no specific hot spot.
Conclusion EPHB4 loss-of-function variants can be associated with HHT-like hepatic abnormalities and should be tested for atypical HHT presentations.
- Cardiovascular Abnormalities
- Phenotype
- Liver Diseases
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Footnotes
Twitter @MiikkaVikkula
Contributors AG, SD-G, MV, ME, PJV and SG conceived the study and analysed the data. SD-G, OE, SR, JS, MK, CL, HM, PM, LA, DL, AP, VL, CV and LG provided clinical cases. AG wrote the manuscript. SD-G, OE, CL, AP, ME, PJV and SG corrected the manuscript. All authors reviewed and approved the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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