Aamir Mohammad Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India
Syed Shamayal Rabbani Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India
Hamid Ashraf Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India
Ahmad Alam Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, India
Mohd Azam Haseen Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India
Address for correspondence: Aamir Mohammad, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India E-mail: aamir.cmc@gmail.com
Rabbani SS, Mohammad A, Ashraf H, et al. Cardioembolic stroke as an initial presentation of Carney's complex: a case report. J Cardiovasc Med Surg. 2024;10(1-2):45-50.
Rabbani SS, Mohammad A, Ashraf H, et al. Cardioembolic stroke as an initial presentation of Carney's complex: a case report. J Cardiovasc Med Surg. 2024;10(1-2):45-50.
Timeline
Received : April 28, 2024
Accepted : June 16, 2024
Published : June 24, 2024
Abstract
Carney Complex (CNC) is a hereditary lentiginosis syndrome caused by mutations in the PRKAR1A gene, leading to abnormalities in the cyclic AMP-dependent protein kinase (PKA) signalling pathway. This condition predisposes individuals to pigmented lesions, myxomas, and endocrine tumors. We present a case of a 28-year-old male diagnosed with CNC after experiencing a cardioembolic stroke due to a left ventricular myxoma. The diagnosis was suspected following a clinical examination that revealed small, well-demarcated, light brown skin lesions around the eyes and over the back. These characteristic skin findings, combined with the presence of cardiac myxomas, raised the suspicion of CNC. Although CNC typically presents with endocrine abnormalities, this case exemplifies a less common presentation. Our report emphasizes the importance of recognizing the diverse phenotypic spectrum of CNC and the need for awareness of this rare, often under diagnosed syndrome.
References
1. Stratakis CA, Kirschner LS, Carney JA. Clinical and molecular features of the Carney complex: diagnostic criteria and recommendations for patient evaluation. J Clin Endocrinol Metab. 2001 Sep;86(9):4041-6. doi: 10.1210/jcem.86.9.7903. PMID: 11549623.
2. Stratakis CA. Carney Complex. 2003 Feb 5 [Updated 2023 Sep 21]. In: Adam MP, Feldman J, Mirzaa GM, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 2024-1993.
3. Chatzikonstantinou S, Kazis D, Giannakopoulou P, Poulios P, Pikou O, Geroukis T, Lyssikatos C, Stratakis CA, Bostanjopoulou S. Carney complex syndrome manifesting as cardioembolic stroke: a case report and review of the literature. Int J Neurosci. 2022 Jul;132(7):649-655. doi: 10.1080/00207454.2020.1834393. Epub 2020 Nov 10. PMID: 33027596.
4. Nomoto N, Tani T, Konda T, Kim K, Kitai T, Ota M, Kaji S, Imai Y, Okada Y,Furukawa Y. Primary and metastatic cardiac tumors: echocardiographic diagnosis,treatment and prognosis in a 15-years single center study. J CardiothoracSurg. 2017 Nov 28;12(1):103.
5. Centofanti P, Di Rosa E, Deorsola L, Dato GM, Patane F, La Torre M, et al.Primary cardiac tumors: early and late results of surgical treatment in 91 patients.Ann Thorac Surg. 1999;68:1236–41.
6. Bireta C, Popov AF, Schotola H, Trethowan B, Friedrich M, El-Mehsen M,Schoendube FA, Tirilomis T. Carney-Complex: multiple resections of recurrentcardiac myxoma. J Cardiothorac Surg. 2011 Feb 3;6:12. doi: 10.1186/1749-8090-6-12. PMID: 21291531; PMCID: PMC3038896.
7. Kuyama N, Hamatani Y, Fukushima S, Ikeda Y, Nakai E, Okada A, Takahama H, Amaki M, Hasegawa T, Sugano Y, Kanzaki H, Fujita T, Ishibashi-Ueda H, Yasuda S, Anzai T, Kobayashi J. Left ventricular myxoma with Carney complex. ESC Heart Fail. 2018 Aug;5(4):713-715. doi: 10.1002/ ehf2.12282. Epub 2018 Mar 15. PMID: 29542870; PMCID: PMC6073037.
8. Briassoulis G, Kuburovic V, Xekouki P, Patronas N, Keil MF, Lyssikatos C, Stajevic M, Kovacevic G, Stratakis CA. Recurrent left atrial myxomas in Carney complex: a genetic cause of multiple strokes that can be prevented. J Stroke Cerebrovasc Dis. 2012 Nov;21(8):914.e1-8. doi: 10.1016/j.jstrokecer ebrovasdis.2012.01.006. Epub 2012 Feb 15. PMID: 22341669; PMCID: PMC3369015.
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All authors contributed significantly to the work and approve its publication.
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Cite this article
Rabbani SS, Mohammad A, Ashraf H, et al. Cardioembolic stroke as an initial presentation of Carney's complex: a case report. J Cardiovasc Med Surg. 2024;10(1-2):45-50.
Rabbani SS, Mohammad A, Ashraf H, et al. Cardioembolic stroke as an initial presentation of Carney's complex: a case report. J Cardiovasc Med Surg. 2024;10(1-2):45-50.
Rabbani SS, Mohammad A, Ashraf H, et al. Cardioembolic stroke as an initial presentation of Carney's complex: a case report. J Cardiovasc Med Surg. 2024;10(1-2):45-50.
Clinical photo – small well demarcated macules light brown in color over the back and around the eyes (red arrow)
Description: No description available.
CT Brain – Image suggestive of sub-acute infarct (red arrow) involving left fronto-parietal-temporal lobe with gyriform hyperdensities with CT value of blood noted within the infarct (hemorrhagic transformation)
Description: No description available.
ECHO – A mass of size 2.7 x 1.5 cm is seen attached to the LV apex with a stalk with a high embolic potential (red asterix). Regional wall motion abnormality present in the LAD territory. No chamber enlargement and all valves are within normal limits. LV – Left ventricle, LA – Left atrium
Description: No description available.
MRI cardiac –A 3.2 x 2.5 cm pedunculated mass seen arising from the LV apex with with heterogenous signal enhancement in T1 and T2 sequences (red arrow) (Source: https://learningradiology.com/notes/ cardiacnotes/leftventthrombus.htm)
Description: No description available.
CAG - A coronary angiogram showing an ostio-proximal lesion of LAD/D1 around 80-90% with diffusely diseased LAD (red arrow)
Description: No description available.
Surgical specimen – A 3 x 2 cm fleshy reddish mass excised from the apex of the left ventricle.
Description: No description available.
HPE - H and E stained section shows stellate to spindle cells with eosinophilic cytoplasm with indistinct border within myxoid stroma.