A 45-year-old man's vague symptoms and unusual medical history spurred an investigation that culminated with an examination of his genes. The patient presented to his primary care physician with a 2-week history of progressive fatigue and 2 episodes of intermittent left upper- and lower-extremity weakness. An extensive work-up for a cause was unrevealing. Magnetic resonance imaging (MRI) of the brain demonstrated bilateral chronic infarcts resulting from multiple cryptogenic strokes in his past medical history. Blood tests revealed unexplained lymphocytosis and thrombocytosis. An 18F-fluorodeoxyglucose-positron emission tomography-computed tomography scan was performed to further evaluate his signs and symptoms. Imaging disclosed abnormal uptake in the adrenal glands, which was concerning for malignancy. The patient was referred to the Mayo Clinic.
PatientID: None
KindredID: 1
Case: M, 45Y0M, Ethnicity Unknown
DiseaseAssertion: Assumed VHL
FamilyInfo: None.
CasePresentingHPOs: HP:0006748, HP:0100827, HP:0001894, HP:0009713, HP:0031496 (Adrenal pheochromocytoma, lymphocytosis, thrombocytosis, spinal hemangioblastoma, mucinous cystic neoplasm of the pancreas)
CaseHPOFreeText: At age 45 the patient was admitted for 2-week history of fatigue and muscle weekness. MRI showed bilateral chronic infarcts resulting from multiple cryptogenic strokes in his past medical history. Blood tests revealed unexplained lymphocytosis and thrombocytosis.The patient was found to have bilateral adrenal phoechromocytomas, hemangioblastomas in the spinal cord at T11 and in the cauda equina at L2, and multiple intraductal papillary mucinous neoplasms.
CaseNotHPOs: HP:0005584, HP:0030405 (renal cell carcinoma, pancreatic endocrine tumour)
CaseNotHPOFreeText: N/A
CasePreviousTesting: N/A
PreviouslyPublished: N/A
SupplementalData: N/A
Variant: p.Y98H (c.292T>C)
CaseProblemVariantFreeText: N/A
LegacyVariant: N/A
ClinVarID: 2223 https://www.ncbi.nlm.nih.gov/clinvar/variation/2223/
CAID: N/A
gnomAD: 0.00001343 https://gnomad.broadinstitute.org/variant/3-10183823-T-C
VariantEvidence: N/A
MutationType: missense_variant;transition
CivicName: Y98H (c.292T>C)
MultipleGeneVariants: N/A