Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Bloom Syndrome (Congenital Telangiectatic Erythema) Workup

  • Author: Amira M Elbendary, MBBCh, MSc; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Dec 14, 2015
 

Laboratory Studies

The diagnosis of Bloom syndrome (congenital telangiectatic erythema) can be confirmed or excluded by a laboratory test known as a chromosome study; blood and skin cells show a characteristic pattern of chromosome breakage and rearrangement. Testing for chromosome instability, including the presence of quadriradicals and increased sister chromatid exchanges, is performed at the US National Institutes of Health and US Armed Forces Institute of Pathology laboratories.

Prenatal diagnosis

Prenatal diagnosis of Bloom syndrome is possible with amniocentesis for amniotic fluid cell culture to assess for a high number of sister chromatid exchanges; DNA analysis will be available in the near future.

Genetic screening and counseling

Genetic screening is recommended for populations at high risk for being a carrier of the disease, such as Ashkenazi Jews. Targeted mutation analysis and polymerase chain reaction (PCR) to examine the DNA for the BLM 6-deletion/7-insertion mutation should be performed.

Genetic counseling could be offered to parents of patients with Bloom syndrome. Being an autosomal recessive disease in its mode of transmission, the risk of having the disease in siblings of heterozygous carriers is estimated to be 25%.[29]

Screening for complications

Immunoglobulin levels should be checked; decreased immunoglobulin A and immunoglobulin M, with or without immunoglobulin G changes, are expected.

Periodic evaluation for leukemia and early screening for breast, cervical, and colorectal cancers are recommended. MRI and ultrasonography are recommended rather than other radiologic diagnostic modalities, in order to minimize the exposure to radiation in such vulnerable patients.

Next

Other Tests

See the Workup section in the Medscape article Short Stature for detailed information on the workup for short stature.

Evaluation of children with photosensitivity

Phototesting and photopatch testing could be performed. Screening for antinuclear antibodies (ANA) and performing a porphyrin profile to exclude the possibility of lupus erythematosus or erythropoietic porphyria may be warranted.

Skin biopsy

Histopathologic findings from skin biopsies taken from the erythematous lesions show a lupuslike picture: follicular plugging, interface dermatitis, monocellular infiltrate, and perivascular infiltrate. However, the presence of changes in the basement membrane, periadnexal lymphocytic infiltration, and dermal mucin are very rare.[28] Bandlike dense lymphoid infiltrates with epidermotropism, resembling mycosis fungoides, have been reported.

Previous
 
 
Contributor Information and Disclosures
Author

Amira M Elbendary, MBBCh, MSc Visiting Research Fellow, Ackerman Academy of Dermatopathology; Teaching Assistant, Department of Dermatology, Kasr Alainy University Hospital, Cairo University, Egypt

Amira M Elbendary, MBBCh, MSc is a member of the following medical societies: Medical Dermatology Society, Bloom’s Syndrome Association, Egyptian Medical Syndicate, International Dermoscopy Society

Disclosure: Nothing to disclose.

Coauthor(s)

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Van Perry, MD Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Eleanor E Sahn, MD Director, Division of Pediatric Dermatology, Associate Professor, Departments of Dermatology and Pediatrics, Medical University of South Carolina

Eleanor E Sahn, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Amir A Bajoghli, MD Clinical Assistant Professor of Dermatology, George Washington University School of Medicine and Georgetown University; Chief, Dermatology and Mohs Surgery Section, Inova Fairfax Hospital; Dermatologist, Skin and Laser Surgery Center, PC

Amir A Bajoghli, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

References
  1. Bloom D. Congenital telangiectatic erythema resembling lupus erythematosus in dwarfs; probably a syndrome entity. AMA Am J Dis Child. 1954 Dec. 88(6):754-8. [Medline].

  2. Straughen J, Ciocci S, Ye TZ, et al. Physical mapping of the bloom syndrome region by the identification of YAC and P1 clones from human chromosome 15 band q26.1. Genomics. 1996 Jul 1. 35(1):118-28. [Medline].

  3. Park CJ, Ko J, Ryu KS, Choi BS. Solution structure of the RecQ C-terminal domain of human Bloom syndrome protein. J Biomol NMR. 2014 Feb. 58(2):141-7. [Medline].

  4. Kim SY, Hakoshima T, Kitano K. Structure of the RecQ C-terminal domain of human Bloom syndrome protein. Sci Rep. 2013 Nov 21. 3:3294. [Medline].

  5. Salah GB, Salem IH, Masmoudi A, Rhouma BB, Turki H, Fakhfakh F, et al. Chromosomal instability associated with a novel BLM frameshift mutation (c.1980-1982delAA) in two unrelated Tunisian families with Bloom syndrome. J Eur Acad Dermatol Venereol. 2014 Oct. 28(10):1318-23. [Medline].

  6. Payne M, Hickson ID. Genomic instability and cancer: lessons from analysis of Bloom's syndrome. Biochem Soc Trans. 2009 Jun. 37:553-9. [Medline].

  7. Seki M, Nakagawa T, Seki T, et al. Bloom helicase and DNA topoisomerase IIIalpha are involved in the dissolution of sister chromatids. Mol Cell Biol. 2006 Aug. 26(16):6299-307. [Medline].

  8. LaRocque JR, Stark JM, Oh J, Bojilova E, Yusa K, Horie K, et al. Interhomolog recombination and loss of heterozygosity in wild-type and Bloom syndrome helicase (BLM)-deficient mammalian cells. Proc Natl Acad Sci U S A. 2011 Jul 19. 108(29):11971-6. [Medline]. [Full Text].

  9. Risch N, Tang H, Katzenstein H, Ekstein J. Geographic distribution of disease mutations in the Ashkenazi Jewish population supports genetic drift over selection. Am J Hum Genet. 2003 Apr. 72(4):812-22. [Medline]. [Full Text].

  10. Nicotera TM, Notaro J, Notaro S, Schumer J, Sandberg AA. Elevated superoxide dismutase in Bloom's syndrome: a genetic condition of oxidative stress. Cancer Res. 1989 Oct 1. 49(19):5239-43. [Medline].

  11. Deans AJ, West SC. FANCM connects the genome instability disorders Bloom's Syndrome and Fanconi Anemia. Mol Cell. 2009 Dec 25. 36(6):943-53. [Medline].

  12. Guo R, Xu D, Wang W. Identification and analysis of new proteins involved in the DNA damage response network of Fanconi anemia and Bloom syndrome. Methods. 2009 May. 48(1):72-9. [Medline]. [Full Text].

  13. Bugreev DV, Mazina OM, Mazin AV. Bloom syndrome helicase stimulates RAD51 DNA strand exchange activity through a novel mechanism. J Biol Chem. 2009 Sep 25. 284(39):26349-59. [Medline]. [Full Text].

  14. Zbinden I, Cerutti P. Near-ultraviolet sensitivity of skin fibroblasts of patients with Bloom's syndrome. Biochem Biophys Res Commun. 1981 Feb 12. 98(3):579-87. [Medline].

  15. Lehmann AR, Kirk-Bell S, Arlett CF, Paterson MC, Lohman PH, de Weerd-Kastelein EA, et al. Xeroderma pigmentosum cells with normal levels of excision repair have a defect in DNA synthesis after UV-irradiation. Proc Natl Acad Sci U S A. 1975 Jan. 72(1):219-23. [Medline]. [Full Text].

  16. Hütteroth TH, Litwin SD, German J. Abnormal immune responses of Bloom's syndrome lymphocytes in vitro. J Clin Invest. 1975 Jul. 56(1):1-7. [Medline]. [Full Text].

  17. Li L, Eng C, Desnick RJ, German J, Ellis NA. Carrier frequency of the Bloom syndrome blmAsh mutation in the Ashkenazi Jewish population. Mol Genet Metab. 1998 Aug. 64(4):286-90. [Medline].

  18. Preston K. Bloom's syndrome. Australas J Dermatol. 1973 Dec. 14(3):143-50. [Medline].

  19. Passarge E. Bloom’s syndrome. German J, ed. Chromosome Mutation and Neoplasia. New York, NY: Alan R. Liss; 1983. 11–21.

  20. Vojtková J, Čiljaková M, Jeseňák M, Mišovicová N, Bánovčin P. Bloom syndrome without typical sun-sensitive skin lesions in three Slovak siblings. Int J Dermatol. 2015 Sep 4. [Medline].

  21. Bhisitkul RB, Rizen M. Bloom syndrome: multiple retinopathies in a chromosome breakage disorder. Br J Ophthalmol. 2004 Mar. 88(3):354-7. [Medline]. [Full Text].

  22. Sultan SJ, Sultan ST. Bloom syndrome in two siblings. Pediatr Dermatol. 2010 Mar-Apr. 27(2):174-7. [Medline].

  23. German J. The immunodeficiency of Bloom syndrome. Ochs HD, Smith CIE, Puck JM, eds. Primary Immunodeficiency Diseases: A Molecular and Genetic Approach. New York, NY: Oxford University Press; 1999. 335.

  24. Amor-Guéret M. Bloom syndrome, genomic instability and cancer: the SOS-like hypothesis. Cancer Lett. 2006 May 8. 236(1):1-12. [Medline].

  25. Relhan V, Sinha S, Bhatnagar T, Garg VK, Kochhar A. Bloom syndrome with extensive pulmonary involvement in a child. Indian J Dermatol. 2015 Mar-Apr. 60 (2):217. [Medline].

  26. Nair G, Lobo I, Jayalaksmi TK, Uppe A, Jindal S, Chandra A, et al. Bloom syndrome with lung involvement. Lung India. 2009 Jul. 26 (3):92-4. [Medline].

  27. Garcia AM, Salomon RN, Witsell A, Liepkalns J, Calder RB, Lee M, et al. Loss of the Bloom Syndrome helicase increases DNA ligase 4-independent genome rearrangements and tumorigenesis in aging Drosophila. Genome Biol. 2011 Dec 19. 12(12):R121. [Medline].

  28. McGowan J, Maize J, Cook J. Lupus-Like Histopathology in Bloom Syndrome: Reexamining the Clinical and Histologic Implications of Photosensitivity. Am J Dermatopathol. 2009 Oct 8. [Medline].

  29. Arora H, Chacon AH, Choudhary S, McLeod MP, Meshkov L, Nouri K, et al. Bloom syndrome. Int J Dermatol. 2014 Jul. 53(7):798-802. [Medline].

  30. Thomas ER, Shanley S, Walker L, Eeles R. Surveillance and treatment of malignancy in Bloom syndrome. Clin Oncol (R Coll Radiol). 2008 Jun. 20(5):375-9. [Medline].

  31. Chisholm CA, Bray MJ, Karns LB. Successful pregnancy in a woman with Bloom syndrome. Am J Med Genet. 2001 Aug 1. 102(2):136-8. [Medline].

  32. Kaneko H, Inoue R, Fukao T, Kasahara K, Tashita H, Teramoto T, et al. Two Japanese siblings with Bloom syndrome gene mutation and B-cell lymphoma. Leuk Lymphoma. 1997 Nov. 27(5-6):539-42. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.