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1G&#62; A&#41; associada &#224; s&#237;ndrome de Coffin&#8208;Siris tipo 2 &#40;autoss&#244;mica dominante&#41;&#44; OMIM 614607&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A s&#237;ndrome de Coffin&#8208;Siris &#233; uma s&#237;ndrome de malforma&#231;&#227;o cong&#234;nita rara&#44; da qual foram descritos menos de 200 casos&#44; e &#233; causada por muta&#231;&#245;es em v&#225;rios genes que codificam componentes do complexo BRG1&#47;BRM associated factor &#40;BAF&#41;&#44; com 12 subtipos diferentes dependendo da muta&#231;&#227;o gen&#233;tica&#44; incluindo &#40;da maior para a menor propor&#231;&#227;o de casos&#41; ARID1B&#44; SMARCB&#44; SMARCA4&#44; ARID1A&#44; SOX11<span class="elsevierStyleItalic">&#44;</span> SMARCE1 e PHF6&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1&#44;2</span></a> O complexo BAF &#233; um remodelador de cromatina dependente de ATP e est&#225; envolvido na transcri&#231;&#227;o e diferencia&#231;&#227;o celular e reparo do DNA&#59; parece haver uma correla&#231;&#227;o fen&#243;tipo&#8208;gen&#243;tipo&#44; porque muta&#231;&#245;es no BAF t&#234;m sido relacionadas a anormalidades no cabelo&#44; unhas e quirod&#225;ctilos&#46; &#201; uma s&#237;ndrome clinicamente heterog&#234;nea&#44; cujos principais sinais incluem atraso cognitivo ou de desenvolvimento discreto a grave&#44; caracter&#237;sticas faciais grosseiras e hipoplasia ou aplasia ungueal e da falange distal do quinto quirod&#225;ctilo e&#44; ocasionalmente&#44; de quirod&#225;ctilos adicionais &#40;os podod&#225;ctilos geralmente s&#227;o afetados em indiv&#237;duos com envolvimento de m&#250;ltiplos dedos&#41;&#46; Essas caracter&#237;sticas faciais distintas incluem sobrancelhas grossas e c&#237;lios longos&#44; ponte nasal ampla&#44; boca larga com l&#225;bios grossos e evertidos e posi&#231;&#227;o anormal do pavilh&#227;o auricular&#46; Outras caracter&#237;sticas menores incluem hipotonia&#44; hirsutismo ou hipertricose e cabelos escassos no couro cabeludo&#44; baixa estatura&#44; dificuldades de alimenta&#231;&#227;o&#44; crescimento lento e anomalias cong&#234;nitas&#44; incluindo microcefalia&#44; manifesta&#231;&#245;es oftalmol&#243;gicas e malforma&#231;&#245;es card&#237;acas&#44; gastrintestinais&#44; geniturin&#225;rias e do sistema nervoso&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1&#44;3&#44;4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">O diagn&#243;stico diferencial inclui s&#237;ndrome de braquimorfismo&#8208;onicodisplasia&#8208;disfalangismo &#40;BOD&#41;&#44; trissomia 9 em mosaico&#44; s&#237;ndrome DOORS &#40;surdez&#44; onicodistrofia&#44; osteodistrofia&#44; defici&#234;ncia intelectual&#41;&#44; embriopatia fetal por hidanto&#237;na&#47;fenito&#237;na&#44; dist&#250;rbios do espectro alco&#243;lico fetal&#44; s&#237;ndrome de Mabry&#44; s&#237;ndrome de Cook&#44; s&#237;ndrome de Zimmermann&#8208;Laband&#44; s&#237;ndrome unha&#8208;patela e s&#237;ndrome de Iso&#8208;Kikuchi&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> resume as semelhan&#231;as e diferen&#231;as cl&#237;nicas desses diagn&#243;sticos diferenciais em rela&#231;&#227;o &#224; s&#237;ndrome de Coffin&#8208;Siris&#44; cujo diagn&#243;stico definitivo &#233; gen&#233;tico&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">O manejo dos pacientes com diagn&#243;stico de s&#237;ndrome de Coffin&#8208;Siris &#233; sintom&#225;tico e consiste em terapias ocupacionais&#44; f&#237;sicas e alimentares&#44; incluindo suplementa&#231;&#227;o nutricional e&#47;ou coloca&#231;&#227;o de sonda de gastrostomia conforme necess&#225;rio&#46; O progn&#243;stico depende da extens&#227;o do envolvimento&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o anual por diferentes especialistas &#233; necess&#225;ria&#44; como otorrinolaringologista&#44; oftalmologista&#44; neurologista e&#47;ou gastroenterologista para avaliar o progresso do desenvolvimento e as interven&#231;&#245;es terap&#234;uticas e educacionais necess&#225;rias&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A s&#237;ndrome de Coffin&#8208;Siris &#233; uma s&#237;ndrome clinicamente heterog&#234;nea&#46; Embora o envolvimento das unhas e a hipoplasia dos dedos possam estar entre os sinais cl&#237;nicos menos graves&#44; os dermatologistas devem estar familiarizados com essas manifesta&#231;&#245;es&#44; que muitas vezes s&#227;o fundamentais para estabelecer o diagn&#243;stico&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0050" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0055" class="elsevierStylePara elsevierViewall">Alba Navarro&#8208;Bielsa&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o dos dados ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Daniel Ruiz Ruiz&#8208;de&#8208;Larramendiz&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o dos dados ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Pilar Abenia&#8208;Us&#243;n&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o dos dados ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Tamara Gracia&#8208;Caza&#241;a&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o dos dados ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Yolanda Gilaberte&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o dos dados ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0080" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Navarro&#8208;Bielsa A&#44; Ruiz&#8208;de&#8208;Larramendiz DR&#44; Abenia&#8208;Us&#243;n P&#44; Gracia&#8208;Caza&#241;a T&#44; Gilaberte Y&#46; Nail dysplasia and digital hypoplasia &#8208; Coffin&#8208;Siris syndrome&#46; An Bras Dermatol&#46; 2024&#59;99&#58;749&#8211;52&#46;</p>"
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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imagens cl&#237;nicas com onicodistrofia &#40;A&#8208;B&#41; e radiogr&#225;ficas &#40;C&#8208;D&#41; mostrando hipoplasia das falanges distais do 2&#176;&#44; 3&#176;&#44; 4&#176; e 5&#176; quirod&#225;ctilos&#44; aus&#234;ncia de falanges distais no 2&#176;&#44; 3&#176;&#44; 4&#176; e 5&#176; podod&#225;ctilos e hipoplasia da falange distal do 1&#176; podod&#225;ctilo&#46;</p>"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">DOORS&#44; surdez&#44; onicodistrofia&#44; osteodistrofia&#44; defici&#234;ncia intelectual&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#237;ndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas cl&#237;nicas semelhantes &#224; s&#237;ndrome de Coffin&#8208;Siris&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas cl&#237;nicas diferentes da s&#237;ndrome de Coffin Siris&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagn&#243;stico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Braquimorfismo&#8208;onicodisplasia&#8208;disfalangismo &#40;BOD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unhas displ&#225;sicas pequenas&#44; quintos dedos curtos&#44; boca ampla com nariz largo&#44; d&#233;ficits intelectuais discretos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sugere&#8208;se que a s&#237;ndrome de Coffin&#8208;Siris e a s&#237;ndrome BOD sejam variantes al&#233;licas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Trissomia 9 em mosaico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipoplasia do quinto d&#237;gito&#44; caracter&#237;sticas faciais&#44; hirsutismo&#44; anomalias cong&#234;nitas card&#237;acas&#44; urogenitais e neurol&#243;gicas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anomalias esquel&#233;ticas e les&#245;es cut&#226;neas em mosaico pigmentar ao longo das linhas de Blaschko&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cari&#243;tipo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">DOORS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Falanges terminais hipopl&#225;sicas e&#47;ou anomalias ungueais&#44; anomalias neurol&#243;gicas&#44; defici&#234;ncia intelectual discreta a grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Surdez&#44; osteodistrofia e convuls&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Variantes patog&#234;nicas bial&#233;licas em TBC1D24&#46; Autoss&#244;mica recessiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Embriopatia fetal por hidanto&#237;na&#47;fenito&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Unhas pequenas com hipoplasia das falanges distais&#44; caracter&#237;sticas faciais dism&#243;rficas&#44; polegares digitalizados&#44; retardo de crescimento&#44; defici&#234;ncias cognitivas&#44; anomalias card&#237;acas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Microcefalia&#44; defeitos oculares&#44; fendas orais&#44; h&#233;rnias umbilicais e inguinais e hiposp&#225;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Hist&#243;ria de exposi&#231;&#227;o &#224; fenito&#237;na durante a gesta&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transtorno do espectro alco&#243;lico fetal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Unhas pequenas&#44; retardo de crescimento pr&#233;&#8208;natal e p&#243;s&#8208;natal&#44; caracter&#237;sticas faciais dism&#243;rficas&#44; defici&#234;ncias cognitivas&#44; anormalidades neurol&#243;gicas&#44; urogenitais e oculares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anormalidades do sistema musculoesquel&#233;tico e auditivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hist&#243;ria de exposi&#231;&#227;o fetal ao &#225;lcool&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">S&#237;ndrome de Mabry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Quinto d&#237;gito hipopl&#225;sico&#44; atraso no desenvolvimento&#44; caracter&#237;sticas faciais grosseiras&#44; hipotonia&#44; defeitos card&#237;acos cong&#234;nitos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Concentra&#231;&#245;es s&#233;ricas elevadas de fosfatase alcalina&#44; convuls&#245;es&#44; fenda palatina&#44; megac&#243;lon&#44; malforma&#231;&#245;es anorretais&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Variantes patog&#234;nicas bial&#233;licas em PIGV&#46; Autoss&#244;mica recessiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;ndrome de Cook&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipo&#47;anon&#237;quia&#44; falanges distais pequenas ou ausentes e digitaliza&#231;&#227;o do polegar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Sem dimorfismo facial&#46; A s&#237;ndrome de Cook &#233; considerada uma forma cl&#237;nica de braquidactilia tipo B &#40;hipoplasia ou aplasia das partes terminais dos quirod&#225;ctilos 2&#8208;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Muta&#231;&#245;es no gene <span class="elsevierStyleItalic">ROR2</span> &#40;9q22&#41;Autoss&#244;mica dominante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;ndrome de Zimmermann&#8208;Laband&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Aus&#234;ncia ou hipoplasia das unhas ou falanges terminais das m&#227;os e p&#233;s e tra&#231;os faciais grosseiros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Fibromatose gengival&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">A base gen&#233;tica &#233; desconhecida&#46; Heran&#231;a autoss&#244;mica dominante foi proposta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Hipertricose&#44; defici&#234;ncias cognitivas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">S&#237;ndrome da unha&#8208;patela&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Hipoplasia ou aplasia ungueal&#44; anomalias renais e oculares&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Disostose patelar&#44; displasia do cotovelo&#44; presen&#231;a de cornos il&#237;acos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Muta&#231;&#245;es no gene <span class="elsevierStyleItalic">LMX1B</span>Autoss&#244;mica dominante&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">S&#237;ndrome de Iso&#8208;Kikuchi&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Anon&#237;quia ou displasia da unha do dedo indicador acompanhada de anomalias &#243;sseas subjacentes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Raramente associada a outras condi&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">A base gen&#233;tica &#233; desconhecidaHeran&#231;a autoss&#244;mica dominante foi proposta&nbsp;\t\t\t\t\t\t\n
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Cartas ‐ Caso clínico
Displasia ungueal e hipoplasia digital - Síndrome de Coffin-Siris
Alba Navarro‐Bielsaa,
Corresponding author
anavarrobi@salud.aragon.es

Autor para correspondência.
, Daniel Ruiz Ruiz‐de‐Larramendizb, Pilar Abenia‐Usónb, Tamara Gracia‐Cazañaa, Yolanda Gilabertea
a Serviço de Dermatologia, Miguel Servet University Hospital, Saragoça, Espanha
b Serviço de Pediatria, Miguel Servet University Hospital, Saragoça, Espanha
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A s&#237;ndrome de Coffin&#8208;Siris &#233; doen&#231;a cong&#234;nita cl&#237;nica e geneticamente heterog&#234;nea&#44; marcada por caracter&#237;sticas faciais grosseiras&#44; defici&#234;ncia intelectual&#44; hipoplasia do quinto quirod&#225;ctilo e aplasia ou hipoplasia ungueal&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Paciente do sexo masculino&#44; de 7 meses de vida&#44; foi atendido no Servi&#231;o de Dermatologia em virtude de doen&#231;a ungueal cong&#234;nita&#46; A crian&#231;a havia sido diagnosticada com megacisterna magna&#44; forame oval perme&#225;vel&#44; hipoplasia renal direita e desenvolvimento psicomotor ligeiramente atrasado com risco de comprometimento do desenvolvimento cognitivo&#46; O exame f&#237;sico revelou displasia de todas as unhas e anon&#237;quia ou micron&#237;quia do 3&#176;&#44; 4&#176; e 5&#176; podod&#225;ctilos e do 4&#176; e 5&#176; quirod&#225;ctilos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1 A&#8208;B</a>&#41;&#46; O paciente apresentava tra&#231;os faciais caracter&#237;sticos&#44; com ponte nasal ampla&#44; boca larga e l&#225;bios grossos&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A radiografia das m&#227;os e dos p&#233;s revelou hipoplasia das falanges distais do 2&#176;&#44; 3&#176;&#44; 4&#176; e 5&#176; dedos das m&#227;os&#44; aus&#234;ncia de falanges distais nos 2&#176;&#44; 3&#176;&#44; 4&#176; e 5&#176; dedos dos p&#233;s e hipoplasia da falange distal do 1&#176; dedo dos p&#233;s &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1 C&#8208;D</a>&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Estudo gen&#233;tico foi realizado&#44; com suspeita de s&#237;ndrome de Coffin&#8208;Siris&#44; e revelou muta&#231;&#227;o heterozig&#243;tica <span class="elsevierStyleItalic">de novo</span> em ARID1A &#40;c&#46;2988 &#43; 1G&#62; A&#41; associada &#224; s&#237;ndrome de Coffin&#8208;Siris tipo 2 &#40;autoss&#244;mica dominante&#41;&#44; OMIM 614607&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">A s&#237;ndrome de Coffin&#8208;Siris &#233; uma s&#237;ndrome de malforma&#231;&#227;o cong&#234;nita rara&#44; da qual foram descritos menos de 200 casos&#44; e &#233; causada por muta&#231;&#245;es em v&#225;rios genes que codificam componentes do complexo BRG1&#47;BRM associated factor &#40;BAF&#41;&#44; com 12 subtipos diferentes dependendo da muta&#231;&#227;o gen&#233;tica&#44; incluindo &#40;da maior para a menor propor&#231;&#227;o de casos&#41; ARID1B&#44; SMARCB&#44; SMARCA4&#44; ARID1A&#44; SOX11<span class="elsevierStyleItalic">&#44;</span> SMARCE1 e PHF6&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1&#44;2</span></a> O complexo BAF &#233; um remodelador de cromatina dependente de ATP e est&#225; envolvido na transcri&#231;&#227;o e diferencia&#231;&#227;o celular e reparo do DNA&#59; parece haver uma correla&#231;&#227;o fen&#243;tipo&#8208;gen&#243;tipo&#44; porque muta&#231;&#245;es no BAF t&#234;m sido relacionadas a anormalidades no cabelo&#44; unhas e quirod&#225;ctilos&#46; &#201; uma s&#237;ndrome clinicamente heterog&#234;nea&#44; cujos principais sinais incluem atraso cognitivo ou de desenvolvimento discreto a grave&#44; caracter&#237;sticas faciais grosseiras e hipoplasia ou aplasia ungueal e da falange distal do quinto quirod&#225;ctilo e&#44; ocasionalmente&#44; de quirod&#225;ctilos adicionais &#40;os podod&#225;ctilos geralmente s&#227;o afetados em indiv&#237;duos com envolvimento de m&#250;ltiplos dedos&#41;&#46; Essas caracter&#237;sticas faciais distintas incluem sobrancelhas grossas e c&#237;lios longos&#44; ponte nasal ampla&#44; boca larga com l&#225;bios grossos e evertidos e posi&#231;&#227;o anormal do pavilh&#227;o auricular&#46; Outras caracter&#237;sticas menores incluem hipotonia&#44; hirsutismo ou hipertricose e cabelos escassos no couro cabeludo&#44; 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como otorrinolaringologista&#44; oftalmologista&#44; neurologista e&#47;ou gastroenterologista para avaliar o progresso do desenvolvimento e as interven&#231;&#245;es terap&#234;uticas e educacionais necess&#225;rias&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A s&#237;ndrome de Coffin&#8208;Siris &#233; uma s&#237;ndrome clinicamente heterog&#234;nea&#46; Embora o envolvimento das unhas e a hipoplasia dos dedos possam estar entre os sinais cl&#237;nicos menos graves&#44; os dermatologistas devem estar familiarizados com essas manifesta&#231;&#245;es&#44; que muitas vezes s&#227;o fundamentais para estabelecer o diagn&#243;stico&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0050" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0055" class="elsevierStylePara elsevierViewall">Alba Navarro&#8208;Bielsa&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o dos dados ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Daniel Ruiz Ruiz&#8208;de&#8208;Larramendiz&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o dos dados ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Pilar Abenia&#8208;Us&#243;n&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o dos dados ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Tamara Gracia&#8208;Caza&#241;a&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o dos dados ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Yolanda Gilaberte&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o dos dados ou an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito ou revis&#227;o cr&#237;tica de conte&#250;do intelectual importante&#59; obten&#231;&#227;o&#44; 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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Navarro&#8208;Bielsa A&#44; Ruiz&#8208;de&#8208;Larramendiz DR&#44; Abenia&#8208;Us&#243;n P&#44; Gracia&#8208;Caza&#241;a T&#44; Gilaberte Y&#46; Nail dysplasia and digital hypoplasia &#8208; Coffin&#8208;Siris syndrome&#46; An Bras Dermatol&#46; 2024&#59;99&#58;749&#8211;52&#46;</p>"
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      1 => array:1 [
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Trabalho realizado no Hospital Miguel Servet&#44; Sarago&#231;a&#44; Espanha</p>"
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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imagens cl&#237;nicas com onicodistrofia &#40;A&#8208;B&#41; e radiogr&#225;ficas &#40;C&#8208;D&#41; mostrando hipoplasia das falanges distais do 2&#176;&#44; 3&#176;&#44; 4&#176; e 5&#176; quirod&#225;ctilos&#44; aus&#234;ncia de falanges distais no 2&#176;&#44; 3&#176;&#44; 4&#176; e 5&#176; podod&#225;ctilos e hipoplasia da falange distal do 1&#176; podod&#225;ctilo&#46;</p>"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">DOORS&#44; surdez&#44; onicodistrofia&#44; osteodistrofia&#44; defici&#234;ncia intelectual&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S&#237;ndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas cl&#237;nicas semelhantes &#224; s&#237;ndrome de Coffin&#8208;Siris&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas cl&#237;nicas diferentes da s&#237;ndrome de Coffin Siris&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagn&#243;stico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Braquimorfismo&#8208;onicodisplasia&#8208;disfalangismo &#40;BOD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unhas displ&#225;sicas pequenas&#44; quintos dedos curtos&#44; boca ampla com nariz largo&#44; d&#233;ficits intelectuais discretos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sugere&#8208;se que a s&#237;ndrome de Coffin&#8208;Siris e a s&#237;ndrome BOD sejam variantes al&#233;licas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Trissomia 9 em mosaico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipoplasia do quinto d&#237;gito&#44; caracter&#237;sticas faciais&#44; hirsutismo&#44; anomalias cong&#234;nitas card&#237;acas&#44; urogenitais e neurol&#243;gicas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anomalias esquel&#233;ticas e les&#245;es cut&#226;neas em mosaico pigmentar ao longo das linhas de Blaschko&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cari&#243;tipo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DOORS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Falanges terminais hipopl&#225;sicas e&#47;ou anomalias ungueais&#44; anomalias neurol&#243;gicas&#44; defici&#234;ncia intelectual discreta a grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Surdez&#44; osteodistrofia e convuls&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Variantes patog&#234;nicas bial&#233;licas em TBC1D24&#46; Autoss&#244;mica recessiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Embriopatia fetal por hidanto&#237;na&#47;fenito&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unhas pequenas com hipoplasia das falanges distais&#44; caracter&#237;sticas faciais dism&#243;rficas&#44; polegares digitalizados&#44; retardo de crescimento&#44; defici&#234;ncias cognitivas&#44; anomalias card&#237;acas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Microcefalia&#44; defeitos oculares&#44; fendas orais&#44; h&#233;rnias umbilicais e inguinais e hiposp&#225;dia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hist&#243;ria de exposi&#231;&#227;o &#224; fenito&#237;na durante a gesta&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transtorno do espectro alco&#243;lico fetal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Unhas pequenas&#44; retardo de crescimento pr&#233;&#8208;natal e p&#243;s&#8208;natal&#44; caracter&#237;sticas faciais dism&#243;rficas&#44; defici&#234;ncias cognitivas&#44; anormalidades neurol&#243;gicas&#44; urogenitais e oculares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anormalidades do sistema musculoesquel&#233;tico e auditivo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hist&#243;ria de exposi&#231;&#227;o fetal ao &#225;lcool&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;ndrome de Mabry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quinto d&#237;gito hipopl&#225;sico&#44; atraso no desenvolvimento&#44; caracter&#237;sticas faciais grosseiras&#44; hipotonia&#44; defeitos card&#237;acos cong&#234;nitos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Concentra&#231;&#245;es s&#233;ricas elevadas de fosfatase alcalina&#44; convuls&#245;es&#44; fenda palatina&#44; megac&#243;lon&#44; malforma&#231;&#245;es anorretais&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Variantes patog&#234;nicas bial&#233;licas em PIGV&#46; Autoss&#244;mica recessiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;ndrome de Cook&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hipo&#47;anon&#237;quia&#44; falanges distais pequenas ou ausentes e digitaliza&#231;&#227;o do polegar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sem dimorfismo facial&#46; A s&#237;ndrome de Cook &#233; considerada uma forma cl&#237;nica de braquidactilia tipo B &#40;hipoplasia ou aplasia das partes terminais dos quirod&#225;ctilos 2&#8208;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muta&#231;&#245;es no gene <span class="elsevierStyleItalic">ROR2</span> &#40;9q22&#41;Autoss&#244;mica dominante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;ndrome de Zimmermann&#8208;Laband&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aus&#234;ncia ou hipoplasia das unhas ou falanges terminais das m&#227;os e p&#233;s e tra&#231;os faciais grosseiros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Fibromatose gengival&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A base gen&#233;tica &#233; desconhecida&#46; Heran&#231;a autoss&#244;mica dominante foi proposta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Hipertricose&#44; defici&#234;ncias cognitivas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;ndrome da unha&#8208;patela&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Hipoplasia ou aplasia ungueal&#44; anomalias renais e oculares&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disostose patelar&#44; displasia do cotovelo&#44; presen&#231;a de cornos il&#237;acos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muta&#231;&#245;es no gene <span class="elsevierStyleItalic">LMX1B</span>Autoss&#244;mica dominante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#237;ndrome de Iso&#8208;Kikuchi&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anon&#237;quia ou displasia da unha do dedo indicador acompanhada de anomalias &#243;sseas subjacentes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Raramente associada a outras condi&#231;&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A base gen&#233;tica &#233; desconhecidaHeran&#231;a autoss&#244;mica dominante foi proposta&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Genetic abnormalities in a large cohort of Coffin&#8208;Siris syndrome patients"
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Article information
ISSN: 26662752
Original language: Portuguese
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