Chondrodysplasia punctata is a term encompassing a group of inherited skeletal dysplasias characterized by calcified deposits on the epiphyseal parts of the bone and cartilage, and they are termed stippling. The clinical presentation somewhat depends on the subtype, but commonly involves shortening of the extremities, facial changes, spinal deformities, ocular abnormalities, developmental delay and congenital heart disease. The diagnosis rests on a thorough clinical workup, imaging studies, and genetic testing.
Chondrodysplasia punctata (CDP) is a term that comprises several congenital disorders with different modes of inheritance. They are rarely encountered in clinical practice and the two principal types are   :
- Brachytelephalangic chondrodysplasia punctata - Considered as a benign form of CDP, Brachytelephalangic CDP occurs due to arylsulfatase E (ARSE) gene mutations that are transferred through X-linked recessive patterns    . As a result, this type is seen almost exclusively in boys . The distal phalanges of the feet and hands exhibit significant shortening (brachytelephalangy), whereas hypoplasia of the midface and the nasal bones are notable facial features   . Patients suffering from this type of CDP do not develop dwarfism or ocular abnormalities, which is typical for more severe forms of CDP - Rhizomelic CDP .
- Rhizomelic chondrodysplasia punctata (RCDP) - Arising due to disruption of normal synthesis of peroxisomes (vital cell membrane constituents) through PEX7 gene mutations, this autosomal recessive type of CDP is distinguished by the presence of early-onset mental retardation and a short stature that predominantly involves the humerus and the femur (termed rhizomelia)     . Facial dysmorphism is more pronounced than in brachytelephalangic CDP, whereas congenital heart disease (seen in up to 50% of patients), cataracts, recurrent respiratory infections, seizures and an overall shorter life span are additional features     . Spinal deformities, such as scoliosis, are seen across all forms of CDP .
Entire Body System
- Failure to Thrive
Abstract Rhizomelic chondrodysplasia punctata is a rare genetic disorder of peroxisomal metabolism that is characterized clinically by shortening of the proximal limbs, cataracts, a characteristic facial appearance, failure to thrive, and psychomotor [ncbi.nlm.nih.gov]
[…] sepsis • Weight at death 2.5 kg (Failure to thrive) 6. Second Child • Antenatal history - ? Polyhydramnios • Term born/3.5kgs/Respiratory distress at birth Nicu stay x 20 days. [de.slideshare.net]
All affected infants have severe failure to thrive, mental retardation, joint contractures, and cataracts. [mhmedical.com]
Jaw & Teeth
In addition, subtle follicular atrophoderma, esotropia, craniofacial asymmetry and short stature were noted. Her history revealed widespread scaly erythema and eye surgery for congenital cataract in the first months of life. [ncbi.nlm.nih.gov]
Le rebeller, an association of Kleinfelter's disease and congenital anomalies, camptodactyly microphakia. Bull Soc Ophtalmol Franc. 1962;62:197-200. 6. Heymans HSA, Oorthuys JWE, Nelck G, Wanders RJA, Schutgens RBH. [healio.com]
A 5-year-old girl presented for evaluation of ill-defined patches of cicatricial alopecia. In addition, subtle follicular atrophoderma, esotropia, craniofacial asymmetry and short stature were noted. [ncbi.nlm.nih.gov]
· Cutaneus abnormalities: ichthyosis and hyperkeratosis; alopecia; layered and split nails. Prognosis - Chondrodysplasia punctata Not supplied. Treatment - Chondrodysplasia punctata Not supplied. Resources - Chondrodysplasia punctata Not supplied. [checkorphan.org]
CDP corresponds to a heterogeneous group of dysplasiascharacterized by punctate calcifications in cartilage (mainly theepiphyseal ones), frequently associated with limbs shortening,cataracts, ichthyosis, alopecia, nervous system alterations,mental and [rb.org.br]
- Follicular Plugging
Skin biopsies from both patients showed thick laminated orthokeratosis and prominent keratotic follicular plugs containing dystrophic calcification. [ncbi.nlm.nih.gov]
Of note, dystrophic calcification observed in keratotic follicular plugs in newborn CDPX2 patients has never been observed in CHILD syndrome. [clinicaladvisor.com]
Ichthyosis and keratotic follicular plugs containing dystrophic calcification in newborns: distinctive histopathologic features of x-linked dominant chondrodysplasia punctata (Conradi-Hünermann-Happle syndrome). [ghr.nlm.nih.gov]
PubMed Google Scholar Hoang MP, Carder KR, Pandya AG, Bennett MJ (2004) Ichthyosis and keratotic follicular plugs containing dystrophic calcification in newborns: distinctive histopathologic features of X-linked dominant chondrodysplasia punctata (Conradi-Hünermann-Happle [link.springer.com]
Face, Head & Neck
- Mid-Face Hypoplasia
At birth, mid-face hypoplasia was marked. Postnatal imaging and genetic analysis confirmed the initial diagnosis. Binder anomaly is probably always associated with CP. The newly revised CP classification facilitates the diagnosis. [ncbi.nlm.nih.gov]
There is mild mid face hypoplasia and a high arched palate. Life expectancy is normal. [advancedradteaching.com]
After delivery the child had significant respiratory distress, and severe nasal and mid-face hypoplasia was noted. The Apgar scores were 1 at 1 min, 5 at 5 min and 6 at 20 min. [nature.com]
The rare occurrence of CDP in general practice (< 1 in 100,000 patients) indicates that the condition may be difficult to diagnose without a thorough workup . For this reason, physicians must perform a complete neurological, cardiorespiratory, and mental examination, preceded by a patient history that will evaluate the potential presence of similar disorders within the family . After the initial assessment, imaging studies should be performed. Ultrasonography and plain radiography are two very useful first-line methods that are able to confirm the presence of epiphyseal stippling and punctate calcifications, as well as hypoplasia of facial bones and the distal extremities  . Ultrasonography provides an additional benefit in that, it has the ability to detect changes prenatally , thus providing sufficient time to plan adequate therapeutic strategies. Moreover, cardiac ultrasonography (both prenatally and postnatally) has been recommended as a mandatory imaging study in CDP patients due to the high rate of congenital heart disease . A comprehensive neurological testing, particularly in the presence of epilepsy (through electroencephalography, evoked potentials, and other similar studies), is also warranted . Finally, genetic testing of both the parents and the patient should be conducted  .
There were two deaths reported, one resulting from conservative treatment and one from surgical treatment. [ncbi.nlm.nih.gov]
Management and treatment There is no specific treatment for the enzyme defect. Prognosis Rhizomelic chondrodysplasia has a severe prognosis with death generally occurring during the first decade of life, mainly due to respiratory complications. [orpha.net]
Treatment Treatment Options: No treatment is available beyond supportive measures. Cataract removal may improve vision but the poor prognosis for longevity requires caution be used. [disorders.eyes.arizona.edu]
Treatment and prognosis While prognosis is variable, the rhizomelic forms can be lethal 3. [radiopaedia.org]
Within the heterogeneous group of chondrodysplasia punctata, the brachytelephalangic type is noteworthy because it has a better prognosis than do the other types. [ncbi.nlm.nih.gov]
Prognosis Rhizomelic chondrodysplasia has a severe prognosis with death generally occurring during the first decade of life, mainly due to respiratory complications. [orpha.net]
Summary Epidemiology Prevalence of the rhizomelic type is estimated at 1 in 100,000. [orpha.net]
Sarcoidosis 514 28 Storage and Deposition Diseases 523 29 The Amyloidoses 533 30 Neoplasms of the Joint 543 31 Heritable Disorders of Connective Tissue 549 32 Bone and Joint Dysplasias 559 33 Osteonecrosis 565 34 Pagets Disease of Bone 573 35 Osteoporosis A Epidemiology [books.google.es]
Plasmalogen levels seem to play an important role in the pathophysiology of CNS abnormalities in RCDP. Increased phytanic acid appears not to be the cause of cerebellar atrophy. [ncbi.nlm.nih.gov]
The condition is acquired in an autosomal recessive manner.  Pathophysiology [ edit ] The mechanism of rhizomelic chondrodysplasia punctata in the case of type 1 of this condition one finds that peroxisome objective is PEX7, in peroxisome assembly. [en.wikipedia.org]
This study emphasizes the need for careful neurological and surgical evaluation of pediatric patients with cervical spine abnormalities affected by CDP or CE in order to prevent progressive instability. [ncbi.nlm.nih.gov]
Prevention - Chondrodysplasia punctata Not supplied. [checkorphan.org]
The main goals for physical therapy are to prevent secondary impairments of RCDP.  Improve contractures related to RCDP Prevention of respiratory complications Management of spasticity Provide cognitive stimulation Can also be a referral source for [physio-pedia.com]
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- Çim A, Coşkun S, Görükmez O, et al. Rhizomelic Chondrodysplasia Punctata Type 1 Caused by a Novel Mutation in the PEX7 Gene. J Clin Res Pediatr Endocrinol. 2015;7(1):69-72.
- Tinnion RJ, Davidson N, Moran P, Wright M, Harigopal S. Rhizomelic chondrodysplasia punctata: a classic “spot” diagnosis. BMJ Case Rep. 2011;2011:bcr0120113747.
- Mason DE, Sanders JO, MacKenzie WG, Nakata Y, Winter R. Spinal deformity in chondrodysplasia punctata. Spine (Phila Pa 1976). 2002;15;27(18):1995-2002.