Abstract:
Background: Pfieffer syndrome is among the syndromes seen in the recognized variant of the FGFR2 gene. There are
several conditions related to this variant and a very closely related condition is Crouzon syndrome. This case is important
to report because the neonate was a delayed referral from another region, without clear counseling and information
on the gravity of situation. We describe additional features , not previously described in Pfieffer or Crouzon
syndrome, supernumerary teeth and localized symmetrical gigantism of thumbs and great toes on both sides. That a
genetic testing is essential to further manage and counsel to avoid lost opportunities for future births. Several cases
are seen in this unit annually, and there is need for a more consolidated and comprehensive counseling and genetic
testing. Once early diagnosis is done and the case is recognized to be untreatable, it was avert the need to refer.
Case presentation: A 2-week-old male African neonate referred from outside the region, presented with massive
proptosis soon after delivery, with signs of pan-ophthalmitis and neonatal sepsis. The infant had additional multiple
malformations and features initially diagnosed as Crouzon syndrome , but later confirmed after genetic testing to be
Type II Pfieffer syndrome. A through clinical evaluation and genetic testing would prevent undue referral to a tertiary
center, or if needed, the baby should have been referred much earlier. The uniqueness of this case is the presence of
supernumerary teeth.
Conclusion: A complicated, difficult to remedy case, referred to tertiary center, investigated, and sent back home
with no significant intervention. Genetic test confirmed the typical findings of Pfieffer Type II. Presented for describing
additional unique features of supernumerary teeth and localized gigantism and ethical challenges in management.
