Arthrogryposis Renal Dysfunction Cholestasis Syndrome: An Uncommon Presentation in a Newborn

Abstract

A preterm baby born at 35 weeks of gestation was noted to have severe limb deformities suggestive of arthrogryposis along with dysmorphic facies and developed seizures, renal dysfunction in addition to cholestasis. MRI brain showed corpus callosum agenesis. Although there are several isolated cases of arthrogryposis, the association with other congenital anomalies are rarely seen. The constellation of anomalies noted in this case along with renal tubular dysfunction and direct hyperbilirubinemia with normal GGT is suggestive of Arthrogryposis renal dysfunction Cholestasis (ARC) syndrome. It is a very rare autosomal recessive multisystem disorder resulting from mutations in the vacuolar protein sorting 33B (VPS33B) or VPS33B-interacting protein, and apical-basolateral polarity regulator (VIPAR) genes. This disorder is associated with a very poor prognosis with children seldom surviving beyond 1 year of age necessitating a detailed genetic evaluation to identify the various mutations and appropriate genetic counselling.