Co-Occurrence of Chronic Mucocutaneous Candidiasis with Woolly Hair

Chronic mucocutaneous candidiasis is an immunodeficiency state, inherited or acquired, characterized by recurrent and/or persistent candidiasis of skin, nails, and mucous membranes. Woolly hair is a congenital structural anomaly of scalp hair, characterized by light-colored, short, extremely kinky, and thin hair due to premature termination of anagen phase of hair cycle. Both conditions are known to present in syndromic and non-syndromic forms. We report the co-occurrence of both these conditions in a 10-year-old female child. The diagnosis was confirmed with clinical, trichoscopic, microbiologic, histopathologic, and laboratory evaluation, though mutational analysis could not be done due to resource constraints. The occurrence of both these diseases in the same individual has not been previously reported to the best of our knowledge. It could be a result of an association with ectodermal dysplasia.

A New Variant Mutation in SKIV2L Gene in Case of Trichohepatoenteric Syndrome

Trichohepatoenteric syndrome is an autosomal recessive genetic disease with an estimated prevalence of 1:100,000. The mutation of the disease is placed either in SKIV2L or TTC37 genes. The onset of presentation is variable, but symptoms usually start with intractable diarrhea associated with woolly hair abnormality, immune dysfunction, and sometimes hepatic abnormality. This case is of a 10-month-old girl who was born at 37 + 2 weeks due to symmetrical intrauterine growth restriction (IUGR), with a low birth weight (1320 g). It was noticed during her stay in NICU that she had excessive diarrhea on day 8. Gastroenterology suggested starting an extensively-hydrolyzed formula, but no improvement noticed. The multidisciplinary teams decided to order whole-exome sequencing analysis after excluding diarrhea causes. The analysis detected a new variant mutation (c.1297C > T) p. (Arg433Cys). To our knowledge, this is the first time detected in a homozygous state in the SKIV2L gene, as this variant mutation has not been described in any previous literature. Our case was managed mainly by total parenteral nutrition. The patient responded to the treatment appropriately.