Abstract
Ellis-van Creveld (EVC) syndrome is a rare, autosomal recessive disorder defined by a classic tetrad of features: chondroectodermal dysplasia causing disproportionate short stature, postaxial polydactyly, ectodermal defects affecting the nails and teeth, and congenital heart disease. The most significant cause of morbidity and mortality is the associated cardiac anomaly, most commonly a large atrial septal defect resulting in a functional common atrium. Early and accurate diagnosis is critical for managing cardiovascular risk and implementing appropriate long-term care.
We report the case of a 12-year-old female from Pakistan, with a weight of 26 kg (BMI 18.8 kg/m²), who presented with a classic EVC phenotype. Clinical examination revealed short-limb dwarfism, bilateral postaxial polydactyly of all four limbs, genu valgum, and ectodermal dysplasia. Her parents were non-consanguineous. Cardiovascular evaluation confirmed a common atrium via echocardiography, with corresponding ECG findings of right axis deviation and an incomplete right bundle branch block. Based on this distinct constellation of clinical and imaging evidence, a clinical diagnosis was made, as molecular genetic testing was not available.
This case confirms the importance of recognizing the distinct clinical phenotype of Ellis-van Creveld syndrome. In settings where molecular diagnostics are unavailable, a confident diagnosis can be made through thorough clinical assessment. Prompt identification is paramount for initiating multidisciplinary management, thereby improving the patient's long-term health and quality of life, with the patient currently awaiting surgical repair of her cardiac defect and referral for orthopedic and dental care.
References
1. Baujat G, Le Merrer M. Ellis-van Creveld syndrome. Orphanet J Rare Dis. 2007: 27 [PMID: 17547743, https://doi.org/10.1186/1750-1172-2-27]
2. Jenkins S, Morrell DS. Ellis-van Creveld syndrome: case report and review of the literature. Cutis. 2009: 303 [PMID: 19681341,
3. McKusick VA, Egeland JA, Eldridge R, Krusen DE. Dwarfism in the Amish I. The Ellis-Van Creveld Syndrome. Bull Johns Hopkins Hosp. 1964: 306 [PMID: 14217223,
4. D'Asdia MC, Torrente I, Consoli F, Ferese R, Magliozzi M, Bernardini L, Guida V, Digilio MC, Marino B, Dallapiccola B, De Luca A. Novel and recurrent EVC and EVC2 mutations in Ellis-van Creveld syndrome and Weyers acrofacial dyostosis. Eur J Med Genet. 2013: 80 [PMID: 23220543, https://doi.org/10.1016/j.ejmg.2012.11.005]
5. Shawky RM, Sadik DI, Seifeldin NS. Ellis–van Creveld syndrome with facial dysmorphic features in an Egyptian child. Egyptian Journal of Medical Human Genetics. 2010: 181 https://doi.org/10.1016/j.ejmhg.2010.05.001]
6. Weiner DS, Jonah D, Leighley B, Dicintio MS, Holmes Morton D, Kopits S. Orthopaedic manifestations of chondroectodermal dysplasia: the Ellis-van Creveld syndrome. J Child Orthop. 2013: 465 [PMID: 24432110, https://doi.org/10.1007/s11832-013-0541-4]
7. Tuna EB, Koruyucu M, Kurklu E, Cifter M, Gencay K, Seymen F, Tuysuz B. Oral and craniofacial manifestations of Ellis-van Creveld syndrome: Case series. J Craniomaxillofac Surg. 2016: 919 [PMID: 27325544, https://doi.org/10.1016/j.jcms.2016.04.025]
8. Hills CB, Kochilas L, Schimmenti LA, Moller JH. Ellis-van Creveld syndrome and congenital heart defects: presentation of an additional 32 cases. Pediatr Cardiol. 2011: 977 [PMID: 21533779, https://doi.org/10.1007/s00246-011-0006-9]
9. Guha A, Malhotra R, Saxena R, Keshri VK. Ellis van creveld syndrome: Cardiac anomalies and anesthetic implications. Ann Card Anaesth. 2023: 346 [PMID: 37470539, https://doi.org/10.4103/aca.aca_166_22]
10. Polymeropoulos MH, Ide SE, Wright M, Goodship J, Weissenbach J, Pyeritz RE, Da Silva EO, Ortiz De Luna RI, Francomano CA. The gene for the Ellis-van Creveld syndrome is located on chromosome 4p16. Genomics. 1996: 1 [PMID: 8661097, https://doi.org/10.1006/geno.1996.0315]
11. Digilio MC, Marino B, Ammirati A, Borzaga U, Giannotti A, Dallapiccola B. Cardiac malformations in patients with oral-facial-skeletal syndromes: Clinical similarities with heterotaxia. American Journal of Medical Genetics. 1999: 350 https://doi.org/10.1002/(sici)1096-8628(19990604)84:4<350::Aid-ajmg8>3.0.Co;2-e]
12. Santos JM, Pipa J, Antunes L, Neves O, Nascimento C, Cabral C, Costa A, Barros O, Carvalho J, Angelo F, et al. [The Ellis-Van Creveld syndrome. Apropos 2 clinical cases]. Rev Port Cardiol. 1994: 45 [PMID: 8155349,
13. Aubert-Mucca M, Huber C, Baujat G, Michot C, Zarhrate M, Bras M, Boutaud L, Malan V, Attie-Bitach T, Clinical C, Cormier-Daire V. Ellis-Van Creveld Syndrome: Clinical and Molecular Analysis of 50 Individuals. J Med Genet. 2023: 337 [PMID: 35927022, https://doi.org/10.1136/jmg-2022-108435]
14. Lauritano D, Attuati S, Besana M, Rodilosso G, Quinzi V, Marzo G, Carinci F. Oral and craniofacial manifestations of Ellis-Van Creveld syndrome: a systematic review. Eur J Paediatr Dent. 2019: 306 [PMID: 31850774, https://doi.org/10.23804/ejpd.2019.20.04.09]
15. Tompson SW, Ruiz-Perez VL, Blair HJ, Barton S, Navarro V, Robson JL, Wright MJ, Goodship JA. Sequencing EVC and EVC2 identifies mutations in two-thirds of Ellis-van Creveld syndrome patients. Hum Genet. 2007: 663 [PMID: 17024374, https://doi.org/10.1007/s00439-006-0237-7]
16. Susami T, Kuroda T, Yoshimasu H, Suzuki R. Ellis-van Creveld syndrome: craniofacial morphology and multidisciplinary treatment. Cleft Palate Craniofac J. 1999: 345 [PMID: 10426602, https://doi.org/10.1597/1545-1569_1999_036_0345_evcscm_2.3.co_2]

This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2025 Syed Muhammad Nayab Ali, MD, Numan Ghani, MD, Mohamed Fawzi Hemida, MD, Syed Azhar Hassan Shirazi, MD, Adnan Shah, MD, Bahlool Khan, MD