EEC-LM-ADULT syndrome caused by R319H mutation in TP63 with ectrodactyly, syndactyly, and teeth anomaly: A case report

Medicine (Baltimore). 2020 Oct 30;99(44):e22816. doi: 10.1097/MD.0000000000022816.


Rationale: Ectrodactyly ectodermal dysplasia-cleft lip/palate (EEC) syndrome, limb-mammary syndrome (LMS), and acro-dermato-ungual-lacrimal-tooth (ADULT) syndrome are caused by a TP63 gene disorder and have similar features. In the present article, a R319H mutation in TP63 is reported, and the correlation between genotype and phenotype is discussed based on the current case and previous literature.

Patient concerns: A 13-year-old Japanese boy had ectrodactyly in the right hand and left foot and syndactyly in the left and right foot, and tooth shape abnormalities.

Diagnoses: Peripheral blood samples were obtained, and mutation analysis was performed. A heterozygous G>A transition at cDNA position 956 of the TP63 gene was found. The patient was diagnosed with ELA (EEC/LM/ADULT) syndrome based on his clinical features and mutation analysis results.

Interventions: The patient underwent surgery to correct the left foot malformation at 1 year of age and the right foot syndactyly at 11 years of age.

Outcomes: No complications were observed after the first and second operations. He can walk comfortably after them, and no additional interventions will be planned in him. We continued to follow up with him up to the present.

Lessons: The concept of ELA syndrome, which is the original concept of combining 3 syndromes (EEC syndrome/LMS/ADULT syndrome) into a unique clinical entity, can help clinicians to better understand TP63-related syndromes and improve the differential diagnosis of these syndromes.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Anodontia / blood*
  • Anodontia / genetics
  • Breast / abnormalities*
  • Cleft Palate / blood*
  • Cleft Palate / genetics
  • Ectodermal Dysplasia / blood*
  • Ectodermal Dysplasia / genetics
  • Fingers / abnormalities*
  • Hand Deformities, Congenital / blood*
  • Hand Deformities, Congenital / genetics
  • Humans
  • Japan
  • Lacrimal Duct Obstruction / blood*
  • Lacrimal Duct Obstruction / genetics
  • Limb Deformities, Congenital / blood*
  • Limb Deformities, Congenital / genetics
  • Male
  • Mutation / genetics
  • Nails, Malformed / blood*
  • Nails, Malformed / genetics
  • Pigmentation Disorders / blood*
  • Pigmentation Disorders / genetics
  • Transcription Factors / analysis*
  • Transcription Factors / blood
  • Tumor Suppressor Proteins / analysis*
  • Tumor Suppressor Proteins / blood


  • TP63 protein, human
  • Transcription Factors
  • Tumor Suppressor Proteins

Supplementary concepts

  • Ectrodactyly-Cleft Palate Syndrome
  • Limb-mammary syndrome
  • Propping Zerres syndrome