Severe facial clefts in acrofacial dysostosis - A consequence of prenatal exposure to mycophenolate mofetil?

BACKGROUND: Immunosuppressants are teratogenic in mice, rats, and rabbits and cause prenatal growth restriction in humans. As yet, there has been no proven teratogenicity in humans. CASE: We present a chromosomally normal fetus with severe acrofacial clysostosis and orofacial clefts. These were bilateral transverse and oblique clefts and defects of the midface. In addition, there were preaxial limb anomalies with digitalization of thumbs and internal cardiovascular, gastrointestinal, and urogenital malformations. The mother had been treated with high doses of the immunosuppressant mycophenolate mofetil in early pregnancy for systemic lupus erythematosus. CONCLUSION: Mycophenolate mofetil may have contributed to or even caused acrofacial clysostosis phenotype and extensive clefting.