Classical-like Ehlers–Danlos syndrome: a clinical description of 20 newly identified individuals with evidence of tissue fragility



Currently, 31 patients with classical-like EDS (clEDS) due to tenascin-X deficiency have been reported in the literature. We report on the clinical and molecular characteristics of 20 additional patients with clEDS to expand knowledge and to enable improved management of this rare genetic disorder.


Patients diagnosed with clEDS by the national EDS service in the UK (n = 21) and abroad (n = 1) were asked for consent for publication of their clinical and molecular data.


Of 22 patients, 20 consented. All patients had typical features of clEDS: joint hypermobility, easy bruising, and skin hyperextensibility without atrophic scars. Importantly, 3/20 patients experienced gastrointestinal complications consisting of small or large bowel ruptures and one esophageal rupture. Other notable observations included two separate occurrences of spontaneous compartment syndrome, suspicion of nonaccidental injury due to significant bruising, and significant clinical variability regarding the debilitating effect of joint dislocations.


We propose a predisposition to tissue fragility, particularly of the gastrointestinal tract in patients with clEDS. As such, clinical and molecular confirmation of this diagnosis is essential. It is recommended to follow up these patients closely to understand the natural history to develop better recommendations for management.

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Fig. 1: Frequent and/or remarkable features in patients with classical-like Ehlers–Danlos syndrome (clEDS).
Fig. 2: TNXB (likely) pathogenic variants identified (likely) pathogenic variants in TNXB gene28.


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We thank the participants for their kind cooperation, and we are grateful to Dr Cristopher Record for his clinical involvement.

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Correspondence to Glenda Sobey MBChB, FCDerm or Fleur S. van Dijk MD, PhD.

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Green, C., Ghali, N., Akilapa, R. et al. Classical-like Ehlers–Danlos syndrome: a clinical description of 20 newly identified individuals with evidence of tissue fragility. Genet Med (2020).

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  • classical-like Ehlers–Danlos syndrome
  • tenascin-X
  • TNXB