Rare multiple congenital anomalies-hypotonia-seizures syndrome type 1 (MCAHS1) - the clinical and molecular summary

Eur J Med Genet. 2023 Jan;66(1):104668. doi: 10.1016/j.ejmg.2022.104668. Epub 2022 Nov 13.


Multiple congenital anomalies-hypotonia-seizures syndrome type 1 (MCAHS1) is a rare autosomal recessive genetic disease belonging to glycosylphosphatidylinositols biosynthesis defects (GPIBD), a group of recessive disorders characterized by intellectual disability, hypotonia, and seizures. Glycosylphosphatidylinositols (GPIs) are glycolipids that anchor and remodel cell proteins. These processes are highly conserved and fundamental in the metabolism of all eukaryotes, including humans. Here, we have reported a male patient presenting with hypotonia, intellectual disability, and epilepsy, who underwent whole exome sequencing (WES). The analysis revealed the presence of two deleterious variants in PIGN that encodes GPI ethanolamine phosphate transferase-1 - one novel (c.1247_1251delAAGTG; p.Glu416Glyfs*22), and one that has been previously reported in the medical literature (c.1434+5G>A) resulting in MCAHS1. The detailed clinical assessment followed by the medical literature review also pointed out transient macrosomia and unreported in MCAHS1 advanced bone age and postnatal tall stature. These symptoms suggest that MCAHS1 shares a phenotypic overlap with disorders associated with overgrowth. To conclude, our case report and summary of the medical literature may be helpful for clinicians and geneticists who diagnose patients presenting with hypotonia accompanied by tall stature, advanced bone age, and transient macrosomia.

Keywords: Epilepsy; Glycosylphosphatidylinositols biosynthesis defects; Intellectual disability; MCAHS1; PIGN.

Publication types

  • Case Reports

MeSH terms

  • Abnormalities, Multiple* / genetics
  • Female
  • Fetal Macrosomia
  • Glycosylphosphatidylinositols
  • Humans
  • Intellectual Disability* / genetics
  • Male
  • Muscle Hypotonia / genetics
  • Mutation
  • Pedigree
  • Phosphotransferases / genetics
  • Seizures / genetics
  • Syndrome


  • Glycosylphosphatidylinositols
  • Phosphotransferases