Case Report: Marfan’s Syndrome with Neurofibromatosis Type-2

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Pashine" }, { "@type": "Person", "name": "Waqar M. Naqvi" }, { "@type": "Person", "name": "Ashish R. Varma" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Background Marfan’s syndrome (MFS) and neurofibromatosis type-2 (NF-2) are rare autosomal dominant diseases caused due to mutations in chromosome number 15 and 22, respectively. The chance of both the diseases occurring in the same patient is extremely rare. Case presentation In this report a rare case of a 16-year-old boy having a coexistence of both MFS and NF-2 is reported. The clinical findings consisted of musculoskeletal abnormalities consisting of laxity of joints, positive Steinberg thumb sign test, positive Walker-Murdoch wrist test, dolichostenomelia, and arachnodactyly. Anthropometric abnormalities reported an increase in lower segment height than the upper segment. Diagnostic assessment revealed pectus carinatum, multiple meningioma, and heterogeneous lesions in bilateral cerebellopontine angle that were ruled out as bilateral schwannoma confirming the diagnosis of MFS and NF-2. However, both must be regarded as novel mutations, and as the position of the two genes is unrelated, it is most probable that two different mutations have occurred. β-blocker was recommended as a prophylactic measure to minimize aortic root stiffness and control aortic root dilatation. Furthermore, surgery and radiation therapy were planned for the management of NF-2; however, the patient expressed skepticism regarding the course of treatment and follow-ups; as a result, this data was reported at the time of discharge with non-specified duration of follow-ups. Conclusions This case report demonstrates a rare case of MFS which is caused due to mutation in chromosome number 15 along with NF-2 which is caused due to mutation in chromosome number 22. Since the positions of the two genes are unrelated, it is concluded that two distinct mutations have occurred. As a result, this report highlights a rare coexistence of both mutations, which will benefit the medical profession in enhancing future studies. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-388", "name": "Case Report: Marfan’s Syndrome with Neurofibromatosis Type-2" } } ] } Home Browse Case Report: Marfan’s Syndrome with Neurofibromatosis Type-2 ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Vagha J, Mishra N, Pashine AA et al. Case Report: Marfan’s Syndrome with Neurofibromatosis Type-2 [version 1; peer review: 1 not approved] . F1000Research 2024, 13 :388 ( https://doi.org/10.12688/f1000research.142379.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: Marfan’s Syndrome with Neurofibromatosis Type-2 [version 1; peer review: 1 not approved] Jayant Vagha 1 , Naman Mishra https://orcid.org/0009-0006-6775-6752 2 , Aishwarya A. Pashine https://orcid.org/0000-0002-7414-2242 3 , Waqar M. Naqvi https://orcid.org/0000-0003-4484-8225 4,5 , Ashish R. Varma 6 Jayant Vagha 1 , Naman Mishra https://orcid.org/0009-0006-6775-6752 2 , [...] Aishwarya A. Pashine https://orcid.org/0000-0002-7414-2242 3 , Waqar M. Naqvi https://orcid.org/0000-0003-4484-8225 4,5 , Ashish R. Varma 6 PUBLISHED 25 Apr 2024 Author details Author details 1 Professor, Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India 2 Intern, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India 3 Resident, Department of Cardiovascular and Pulmonary Physiotherapy, Career College, Bhopal, India 4 PhD Scholar, Faculty of Interdisciplinary Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, India 5 Assistant Professor, Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates 6 Professor, Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India Jayant Vagha Roles: Conceptualization, Data Curation, Formal Analysis, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Naman Mishra Roles: Investigation, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Aishwarya A. Pashine Roles: Investigation, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Waqar M. Naqvi Roles: Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing Ashish R. Varma Roles: Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Datta Meghe Institute of Higher Education and Research collection. Abstract Background Marfan’s syndrome (MFS) and neurofibromatosis type-2 (NF-2) are rare autosomal dominant diseases caused due to mutations in chromosome number 15 and 22, respectively. The chance of both the diseases occurring in the same patient is extremely rare. Case presentation In this report a rare case of a 16-year-old boy having a coexistence of both MFS and NF-2 is reported. The clinical findings consisted of musculoskeletal abnormalities consisting of laxity of joints, positive Steinberg thumb sign test, positive Walker-Murdoch wrist test, dolichostenomelia, and arachnodactyly. Anthropometric abnormalities reported an increase in lower segment height than the upper segment. Diagnostic assessment revealed pectus carinatum, multiple meningioma, and heterogeneous lesions in bilateral cerebellopontine angle that were ruled out as bilateral schwannoma confirming the diagnosis of MFS and NF-2. However, both must be regarded as novel mutations, and as the position of the two genes is unrelated, it is most probable that two different mutations have occurred. β-blocker was recommended as a prophylactic measure to minimize aortic root stiffness and control aortic root dilatation. Furthermore, surgery and radiation therapy were planned for the management of NF-2; however, the patient expressed skepticism regarding the course of treatment and follow-ups; as a result, this data was reported at the time of discharge with non-specified duration of follow-ups. Conclusions This case report demonstrates a rare case of MFS which is caused due to mutation in chromosome number 15 along with NF-2 which is caused due to mutation in chromosome number 22. Since the positions of the two genes are unrelated, it is concluded that two distinct mutations have occurred. As a result, this report highlights a rare coexistence of both mutations, which will benefit the medical profession in enhancing future studies. READ ALL READ LESS Keywords Marfan’s Syndrome, Neurofibromatosis Type-2, Autosomal Dominant, Connective Tissue Disease, Chromosomal Mutations Corresponding Author(s) Waqar M. Naqvi ( [email protected] ) Close Corresponding author: Waqar M. Naqvi Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Vagha J et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Vagha J, Mishra N, Pashine AA et al. Case Report: Marfan’s Syndrome with Neurofibromatosis Type-2 [version 1; peer review: 1 not approved] . F1000Research 2024, 13 :388 ( https://doi.org/10.12688/f1000research.142379.1 ) First published: 25 Apr 2024, 13 :388 ( https://doi.org/10.12688/f1000research.142379.1 ) Latest published: 25 Apr 2024, 13 :388 ( https://doi.org/10.12688/f1000research.142379.1 ) Introduction Marfan syndrome (MFS) is an autosomal dominant hereditary connective tissue disease (CTD) with significant presentations in the skeletal, ophthalmic, and cardiovascular systems that are age-related and is caused due to mutation in the protein gene Fibrillin-1 (FBN1) and affects about 1 in 5,000 people worldwide. 1 – 3 De novo variants can be present in up to 25% of patients with MFS, 4 which means that the affected person has a new mutation. It has been shown that MFS is caused by FBN1 missense variations, insertions, deletions, and mutations linked to loss of expression from one allele, 1 , 5 which is released and integrated into the extracellular matrix (ECM). Microfibrils, which are also known as FBN1, play a crucial role in ECM structures and are found in tissues or in close proximity to elastin fibres. 1 Aortic root aneurysms that are asymptomatic, aortic dissections, ocular lens dislocations, and musculoskeletal anomalies with bone overgrowth are the most notable characteristics of MFS. It is not always necessary to perform genetic testing to validate the existence of FBN1 for diagnosis of MFS but can aid in differentiating MFS from other inherited disease syndromes that can demonstrate skeletal characteristics identical to MFS. 6 , 7 Acute aortic dissections, which can be fatal, can develop from untreated aortic root aneurysms. Medical treatment is necessary for MFS to reduce the risk of dissection and slow aneurysm progression. The formation of an aneurysm must be routinely monitored with imaging methods such as echocardiography, Computed Tomography (CT), or Magnetic Resonance Imaging (MRI) in order to determine when precautionary repair surgery should be performed to prevent an acute aortic dissection. 1 The other autosomal dominant disease seen in this case report is Neurofibromatosis type 2 (NF-2), which is marked by schwannomas, meningiomas, and ependymomas. 8 The majority of adult patients with NF-2 have bilateral vestibular schwannomas, which are indicative of NF-2. They typically appear as an augmenting mass that extends from the internal acoustic canal into the cerebellopontine cistern. 8 , 9 These tumours, however, may not always be present or may be too small to be seen on a routine CT or MRI scan. When this occurs, the development of non-tumoral calcifications, either with or without tumoral calcifications, indicate that NF-2 is a probable diagnosis. 8 There may also be other cancers of the neurological system, such as tumours of the intrinsic spinal cord, spinal nerve root schwannomas and intracranial and spinal meningiomas. 9 The coexistence of these two diseases is rare and therefore, this report highlights a rare case of a young boy having MFS along with NF-2. Case report The case report was amended according to the CARE guidelines. Patient information A 16-year-old South Asian boy presented at the Acharya Vinoba Bhave Rural Hospital, Sawangi, India, with the chief complaints of swelling at different sites that was progressing in size all over the body, hearing loss and diminution of vision lasting 3 years along with behavioural disturbances. Additionally, his birth was from non-consanguineous marriage. He had a history of road traffic accident six years before that led to subarachnoid and subdural haemorrhages that were managed conservatively at that time. Clinical findings Physical examination revealed thin built with the swelling at different sites. The musculoskeletal and anthropometric findings were evaluated based on Revised Ghent Criteria for MFS. 1 Anthropometric measurements indicated height of 162 cm and weight of 36 kg, head circumference was found to be 55 cm and arm span was 170 cm. Additionally, upper and lower segment heights were measured separately, which were 65 cm and 97cm, respectively. The thoracic expansion from axillary perimetry was 80.5 cm and xyphoid perimetry was 78.77 cm. Musculoskeletal abnormalities included laxity of joints, a positive Walker-Murdoch wrist test, in which the patient was asked to encircle the wrist with the contralateral hand during which the thumb and the little finger superimposed while encircling the wrist, along with positive Steinberg thumb sign test in which the patient adducted the thumb and flexed the fingers showing distal phalanx of the thumb exceeding the palmar area,as illustrated in Figure 1 . Dolichostenomelia and arachnodactyly were observed. A dense cataract with subluxation of lens, previous detachment of retina, minimal light perception, and iridodonesis were detected during ophthalmology examination in the left eye whereas in the right eye only myopia-related iridodonesis was visible. The results of the laboratory investigations were within normal limits. Figure 1. Walker-Murdoch wrist test. Diagnostic assessment The diagnostic assessment involved X-ray in lateral and posterior-anterior position that was performed for spine, chest, and sternum that revealed pectus carinatum (PC). The degree of scoliosis that was analysed by the Cobb’s angle was 20.76 cm describing moderate scoliosis. The MRI scan revealed multiple meningioma, heterogeneous lesions in bilateral cerebellopontine angle, which were ruled out as bilateral schwannoma of size 3.4×2.8×1.2 cm on the right side and 5.2×5.0×3.8 cm on the left side,as shown in Figure 2A , however bilateral vestibular schwannoma and mass effect caused in the form of compression of cerebellum is shown in Figure 2B . Echocardiogram showed minimal mitral regurgitation. The multiple swellings were diagnosed as NF-2. Based on the above findings he was diagnosed with MFS along with NF-2 for which he was referred for neurosurgeon’s opinion. Figure 2. A: Axial T1 contrast image showing the evidence of enhanced bilateral cerebellopontine angle mass lesion, left yellow arrow showing widening of internal auditory canal, right yellow arrow shows extra-axial enhancing mass with dural tail. B: Coronal T1 contrast image in which both yellow arrows pointing towards bilateral vestibular schwannoma and orange arrow indicating mass effect caused in the form of compression of cerebellum. Differential diagnosis MFS is similar to Loeys-Dietz syndrome (LDS) in clinical features involving aortic aneurysm/dissection and with Shprintzen-Goldberg syndrome (SGS) in having pectus abnormalities, scoliosis, and arachnodactyly. The features that differentiate MFS from LDS include cleft palate, diffuse aortic and arterial aneurysms, thin skin, easy bruising, craniosynostosis, and club foot whereas, features that differentiate MFS from SGS include craniosynostosis, and intellectual disability. 10 The other disease NF-2 is differentially diagnosed from NF-1 that consists of intellectual disability, Lisch nodules, and Café au lait macules. Additionally, NF-1 is caused due to mutation in chromosome number 17 and NF-2 is caused due to mutation in chromosome 22. 11 Therapeutic intervention As a part of the prophylactic measure β-blocker was prescribed to control aortic root dilatation and reduce aortic root stiffness. Additionally, for the management of NF-2 surgery was planned along with occasional radiation therapy but the patient was skeptical about the treatment and follow-ups, hence this data was reported at the time of discharge with non-specified duration of follow-ups. Follow-up and outcomes The diagnostic assessment of X-ray in lateral and posterior-anterior position for spine, chest, and sternum could be assessed for determining the resolving deformities of chest and spine along with the MRI scan in the follow-ups. Hence, the patient was skeptical for the treatment and follow-ups, hence this data was reported at the time of discharge with non-specified duration of follow-ups. Hence, the case report demonstrates the coexistence of two novel mutations leading to MFS and NF-2 in the patient. Discussion The most prevalent inherited CTD, which is MFS, has a wide range of clinical symptoms. 12 MFS is strongly linked to mutations in the FBN1 gene. 12 The pathophysiological effects of the elastic fibres’ deterioration in MFS seem to account for the majority of its symptoms. The most significant effect of elastin degeneration is stiffness and impaired aortic distensibility in response to elevated pulse pressure. 13 Another theory has recently surfaced in an effort to explain the pathophysiology of MFS, which states that the cytokine Transforming Growth Factor β (TGFβ), which controls cell morphogenesis, is thought to contribute to the MFS phenotype. Abnormal fibrillin prevents the latent TGFβ precursor from being sequestered, which causes excessive TGFβ activation, thus eliciting the MFS-specific symptoms as a result. 1 , 12 , 14 The prognosis for these patients is driven by the cardiovascular abnormalities. Therefore, regular cardiovascular monitoring is necessary to increase these patients’ chances of survival. If untreated, people with MFS have a 32-year median life expectancy. 3 The elastic and collagen fibres that give ligaments their flexibility and resistance are connected to the connective tissue, and therefore any alterations in the musculoskeletal system occur if the connective tissue is impaired. Hence, this case report illustrated anthropometric and musculoskeletal changes that occur in patients with MFS. 15 According to histopathological analysis, patients with MFS who underwent muscular biopsy showed fragmentation of fibrillin, which would result in musculoskeletal symptoms. 15 , 16 One of the most frequent MFS symptoms involving changes to the chest wall is the pectus, which is defined by an imbalance in the development of the costochondral cartilages and the cartilaginous plates of the sternum. An earlier study found a high prevalence of PC in this population, which may conclude that PC could occur throughout the growth phase and deteriorate, especially in people with a genetic susceptibility. According to PC’s severity and its relationship to other thoracic abnormalities including kyphosis and scoliosis, respiratory issues related to PC may occur. Because of this, it’s essential to recognize musculoskeletal changes early in order to avoid complications. 15 A genetic disease known as NF-2 is marked by malignancies such as meningiomas, schwannomas, and ependymomas. 8 NF-1 and NF-2 are two independent types of diseases of neurofibromatosis with different diagnostic and clinical findings that result from discrete chromosomes. Inactivation of a tumour suppressor gene that occurs due to mutation on chromosome 17 causes NF-1. However, mutation in the gene on chromosome 22 that encodes a tumour-suppressor protein “Merlin” causes NF-2. The diagnosis of NF-2 is strongly influenced by radiographic examination. The diagnosis is relatively simple when bilateral vestibular schwannomas with the usual appearance of progression into the cerebellopontine cisterns from the internal acoustic canals are observed. However, schwannomas of other nerves, meningiomas, ependymomas, and ocular abnormalities can emerge in some people, particularly children and young adults. Therefore, screening for NF-2 should begin when a young patient presents with one or more schwannomas, as well as numerous extra-axial brain or spine tumours. Small intracanalicular tumours may get easily ignored on MRI in such instances. For this reason, small schwannomas of the vestibular or other cranial nerves should be looked for using axial and coronal thin slice contrast enhanced T1-weighted sequences. 8 In our case, in axial T1 contrast image there is evidence of enhancing bilateral cerebellopontine angle mass lesion along with internal auditory canal with extra axial enhancing mass and dural tail, as shown in Figure 2A ,whereas coronal T1 contrast image is pointing towards bilateral vestibular schwannoma and mass effect caused in the form of compression of cerebellum, as shown in Figure 2B , that confirmed NF-2. The coexistence of these two diseases suggests either a chance occurrence or that the two diseases are etiologically or genetically related. The chances of both the diseases occurring in the same patient is one in 60 million. 17 Mutation in the gene FBN1 on chromosome 15q21 causes MFS, whereas mutation in the gene on chromosome 22 causes NF-2. As a result, both conditions must be considered as different mutations, since the position of the two genes are unrelated, it is most probable that two independent mutations have taken place. Additionally, the diagnosis was reliant on clinical standards as the genetic analysis was not performed for the reason that the patient denied for the test. This was considered as a big limitation of reporting this case. Conclusions This report highlights a rare case of a young boy having coexistence of Marfan’s syndrome along with Neurofibromatosis Type-2 and concludes that when compared to acquired CTD, MFS is rare and inheritable. Since genetic testing is non-specific, the diagnosis is reliant on clinical standards. Despite the morbidity and mortality linked to MFS, lives of many patients can be enhanced or lengthened through appropriate surgical and medical interventions along with future advancements in research. By contrast, NF-2 is a genetic neurocutaneous disease that causes anomalies in the skin and serves as a potential for a variety of brain and spinal cord tumours. MFS is caused due to mutation in chromosome 15, whereas, NF-2 is caused due to mutation in chromosome number 22, since the position of the two genes are unrelated, it concludes that two distinct mutations have taken place hence, this report highlights a rare coexistence of both the mutations, which will prove beneficial for medical profession in enhancing future studies. Patient perspective Three years back, I felt my abilities to hear and see objects clearly were gradually diminishing but I ignored this feeling it might be my misunderstanding. But then 15 days back, I noticed swelling all over my body, which was accompanied with pain. I visited my nearby hospital wherein, I went through tests and got to know that I am having a rare genetic disorder and a close medical attention is required for my well-being. I am in hospital under observation since then. I and my parents had been informed about the rare nature of my disease and importance of its publication. I am not eligible for signing the informed consent, hence, my parental informed consent was signed for publishing my case. Consent Written informed consent for publication of clinical details and images was obtained from the parents of the patient. Data availability No data are associated with this article. References 1. Milewicz DM, Braverman AC, Backer JD, et al. : Marfan Syndrome. Nat. Rev. Dis. Prim. 2021; 7 : 64. PubMed Abstract | Publisher Full Text | Free Full Text 2. Keane MG, Pyeritz RE: Medical Management of Marfan Syndrome. Circulation. 2008; 117 (21): 2802–2813. Publisher Full Text 3. Cheema T, Balek M, Smith P, et al. : A Case Report of Marfan Syndrome Presenting With Atypical Chest Pain: A 28-Year-Old Male With Non-ST-Elevation Myocardial Infarction (NSTEMI). Cureus. 2022; 14 (2): e22040. eCollection 2022 Feb. 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Heart. 2002 Jul; 88 (1): 97–103. PubMed Abstract | Publisher Full Text | Free Full Text 14. Lacro RV, Dietz HC, Wruck LM, et al. : Rationale and design of a randomized clinical trial of beta-blocker therapy (atenolol) versus angiotensin II receptor blocker therapy (losartan) in individuals with Marfan syndrome. Am. Heart J. 2007 Oct; 154 (4): 624–631. PubMed Abstract | Publisher Full Text | Free Full Text 15. Cipriano GFB, Brech GC, Peres PAT, et al. : Anthropometric and musculoskeletal assessment of patients with Marfan syndrome. Rev. Bras. Fisioter. 2011; 15 (4): 291–296. PubMed Abstract | Publisher Full Text 16. Behan WMH, Longman C, Petty RKH, et al. : Muscle fibrillin deficiency in Marfan’s syndrome myopathy. J. Neurol. Neurosurg. Psychiatry. 2003; 74 (5): 633–638. PubMed Abstract | Publisher Full Text | Free Full Text 17. Hartlapp I, Bühring U, Dichgans J, et al. : A patient with Marfan’s syndrome and neurofibromatosis type 1 with polyneuropathy. Eur. J. 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PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 25 Apr 2024 ADD YOUR COMMENT Comment Author details Author details 1 Professor, Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India 2 Intern, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India 3 Resident, Department of Cardiovascular and Pulmonary Physiotherapy, Career College, Bhopal, India 4 PhD Scholar, Faculty of Interdisciplinary Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, India 5 Assistant Professor, Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates 6 Professor, Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India Jayant Vagha Roles: Conceptualization, Data Curation, Formal Analysis, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Naman Mishra Roles: Investigation, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Aishwarya A. Pashine Roles: Investigation, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Waqar M. Naqvi Roles: Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing Ashish R. Varma Roles: Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 25 Apr 2024, 13:388 https://doi.org/10.12688/f1000research.142379.1 Copyright © 2024 Vagha J et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Vagha J, Mishra N, Pashine AA et al. Case Report: Marfan’s Syndrome with Neurofibromatosis Type-2 [version 1; peer review: 1 not approved] . F1000Research 2024, 13 :388 ( https://doi.org/10.12688/f1000research.142379.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 25 Apr 2024 Views 0 Cite How to cite this report: Halper J. Reviewer Report For: Case Report: Marfan’s Syndrome with Neurofibromatosis Type-2 [version 1; peer review: 1 not approved] . F1000Research 2024, 13 :388 ( https://doi.org/10.5256/f1000research.155927.r303150 ) The direct URL for this report is: https://f1000research.com/articles/13-388/v1#referee-response-303150 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 27 Jul 2024 Jaroslava Halper , University of Georgia, Athens, Georgia, USA Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.155927.r303150 This case report describes an interesting coincidence of two diseases caused by mutations in two different genes. Though this is an interesting and really unusual case of coincidental occurrence of two rare diseases, I am not sure how much the ... Continue reading READ ALL This case report describes an interesting coincidence of two diseases caused by mutations in two different genes. Though this is an interesting and really unusual case of coincidental occurrence of two rare diseases, I am not sure how much the report is novel regarding genetic analysis (not done), no mention of family history (it was not attempted) and whether the double disease could affect treatment and/or prognosis (and unfortunate for the patient). The diseases are so uncommon that one cannot suggest be on the lookout. In other words, it does not bring much new information. They described meningiomas, schwannomas as malignancies in the fourth paragraph of the Discussion. There are quite a few types, some grammatical errors which need to be corrected. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? No Is the case presented with sufficient detail to be useful for other practitioners? No Competing Interests: No competing interests were disclosed. Reviewer Expertise: Connective tissue disorders, growth factors I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Halper J. Reviewer Report For: Case Report: Marfan’s Syndrome with Neurofibromatosis Type-2 [version 1; peer review: 1 not approved] . F1000Research 2024, 13 :388 ( https://doi.org/10.5256/f1000research.155927.r303150 ) The direct URL for this report is: https://f1000research.com/articles/13-388/v1#referee-response-303150 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 25 Apr 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 25 Apr 24 read Jaroslava Halper , University of Georgia, Athens, USA Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Halper J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 27 Jul 2024 | for Version 1 Jaroslava Halper , University of Georgia, Athens, Georgia, USA 0 Views copyright © 2024 Halper J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This case report describes an interesting coincidence of two diseases caused by mutations in two different genes. Though this is an interesting and really unusual case of coincidental occurrence of two rare diseases, I am not sure how much the report is novel regarding genetic analysis (not done), no mention of family history (it was not attempted) and whether the double disease could affect treatment and/or prognosis (and unfortunate for the patient). The diseases are so uncommon that one cannot suggest be on the lookout. In other words, it does not bring much new information. They described meningiomas, schwannomas as malignancies in the fourth paragraph of the Discussion. There are quite a few types, some grammatical errors which need to be corrected. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? No Is the case presented with sufficient detail to be useful for other practitioners? No Competing Interests No competing interests were disclosed. Reviewer Expertise Connective tissue disorders, growth factors I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Halper J. Peer Review Report For: Case Report: Marfan’s Syndrome with Neurofibromatosis Type-2 [version 1; peer review: 1 not approved] . F1000Research 2024, 13 :388 ( https://doi.org/10.5256/f1000research.155927.r303150) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-388/v1#referee-response-303150 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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