acenocoumarol

Reactions 1463, p5 - 3 Aug 2013

SAcenocoumarol

Warfarin embryopathy with atlantoaxial dislocationfollowing in utero exposure: case report

A male neonate was born with facial dysmorphism followingin utero exposure to acenocoumarol [Acitrom]; warfarinembryopathy with atlantoaxial dislocation was diagnosed.

The boy was referred to a medical genetics department at1 year and 10 months of age, for evaluation of severe nasalhypoplasia and global developmental delay. His 33-year-oldmother, who had rheumatic heart disease, had undergonemitral valve replacement 2 years before the boy’s birth. Hismother received anticoagulant therapy with acenocoumarol,with the INR maintained in the range of 2–3 [route and dosagenot stated]. Ultrasonography at 5 months of gestation revealedpolyhydramnios but no major fetal malformations. He wasborn at 8 months of gestation, with a birth weight of 1900g. Hedid not cry immediately after birth; facial dysmorphismincluding a depressed nasal bridge was noted. He washospitalised, and ventilated for 15 days. He had repeatedrespiratory tract infections during infancy, requiring ventilationsupport at 2 months of age. At referral, nervous systemexamination revealed hypotonia. Dysmorphic features werenoted, including dolichocephalic head shape, saddle-shapednose with a depressed bridge, hypertelorism, high-archedpalate, brachydactyly with dystrophic nails, and proximallyplaced second and third toes in both feet. Skeletal surveyrevealed punctate calcifications, brachydactyly, scoliosis andatlantoaxial dislocation. On the basis of maternalacenocoumarol intake during pregnancy, warfarinembryopathy with atlantoaxial dislocation was diagnosed.

Author comment: "We report a case of WE [warfarinembryopathy] with the rare complication of AAD [atlantoaxialdislocation]. The clinical diagnosis was made on the basis ofthe history of acitrom ingestion by the mother during earlypregnancy."Agarwal M, et al. Atlantoaxial dislocation in a child affected by warfarinembryopathy: A case report. Clinical Dysmorphology 22: 124-126, No. 3, Jul2013. Available from: URL: http://dx.doi.org/10.1097/MCD.0b013e3283630275 -India 803090649

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Reactions 3 Aug 2013 No. 14630114-9954/13/1463-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved