Two unrelated children with von Recklinghausen's neurofibromatosis (NF1) had mothers with cutaneous NF1 lesions in a limited distribution. The cutaneous pattern in the mother of case 1 was clearly segmental, and probably represents mosaicism for the NF1 mutation which was passed on to the child. In the second case the distribution in the mother was less obviously segmental, but may still represent mosaicism. It is more difficult to diagnose mosaicism for NF1 in individuals with no affected offspring, or with more limited cutaneous manifestations. The difficulties in defining segmental NF and assigning a genetic risk are discussed.
We report a 4-year-old boy with multiple sulphatase deficiency (MSD). His early health was good. By the end of his first year there were concerns about developmental delay but by 26 months he showed clear evidence of regression in that he was barely able to sit unsupported and had lost all fine motor and communication skills. At that time he also had widespread mild ichthyosis that cleared completely with the use of emollients. The neurological deterioration suggested a diagnosis of metachromatic leucodystrophy, and a reduction in the leucocyte arylsulphatase A activity was detected. The ichthyosis suggested steroid sulphatase deficiency, and a reduction in the leucocyte steroid sulphatase activity was detected. The enzyme deficiency was much less marked for steroid sulphatase than for arylsulphatase A in this boy. This diversity in enzyme activities is typical of MSD and correlates with the mild ichthyosis in this child. This case shows that even mild ichthyosis should prompt measurement of steroid sulphatase activity in a child of either sex with unexplained neurological deterioration.
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