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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">lvrach</journal-id><journal-title-group><journal-title xml:lang="ru">Лечащий Врач</journal-title><trans-title-group xml:lang="en"><trans-title>Lechaschi Vrach</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1560-5175</issn><issn pub-type="epub">2687-1181</issn><publisher><publisher-name>ООО «Издательство "Открытые системы"»</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.51793/OS.2026.29.6.008</article-id><article-id custom-type="elpub" pub-id-type="custom">lvrach-1642</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ПЕДИАТРИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>PEDIATRICS</subject></subj-group></article-categories><title-group><article-title>Синдром MIRAGE — долгий путь к диагнозу (клинический случай)</article-title><trans-title-group xml:lang="en"><trans-title>MIRAGE syndrome is a long way to diagnosis (clinical case)</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0008-0929-825X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Рощупкин</surname><given-names>А. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Roschupkin</surname><given-names>A. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Рощупкин Антон Николаевич, к.м.н., доцент кафедры педиатрии</p><p>460014, Оренбург, ул. Советская, 6</p></bio><bio xml:lang="en"><p>Anton N. Roshchupkin, Cand. of Sci. (Med.), Associate Professor of the Pediatrics Department</p><p>6 Sovetskaya str., Orenburg, 460014</p></bio><email xlink:type="simple">roshchupkin_anton@bk.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0006-9982-4414</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Евстифеева</surname><given-names>Г. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Evstifeeva</surname><given-names>G. Yu.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Евстифеева Галина Юрьевна, д.м.н., профессор, заслуженный работник высшей школы Российской Федерации, заведующая кафедрой педиатрии</p><p>460014, Оренбург, ул. Советская, 6</p></bio><bio xml:lang="en"><p>Galina Yu. Evstifeeva, Dr. of Sci. (Med.), Professor, Honored Employee of Higher Education of the Russian Federation, Head of the Pediatrics Department</p><p>6 Sovetskaya str., Orenburg, 460014</p></bio><email xlink:type="simple">gal-evst@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0910-6525</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Данилова</surname><given-names>Е. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Danilova</surname><given-names>E. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Данилова Елена Ивановна, к.м.н., доцент кафедры педиатрии</p><p>460014, Оренбург, ул. Советская, 6</p></bio><bio xml:lang="en"><p>Elena I. Danilova, Cand. of Sci. (Med.), Associate Professor of the Pediatrics Department</p><p>6 Sovetskaya str., Orenburg, 460014</p></bio><email xlink:type="simple">danoilowa@list.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-5728-9998</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ветеркова</surname><given-names>З. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Veterkova</surname><given-names>Z. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Ветеркова Зинаида Александровна, к.м.н., доцент кафедры педиатрии</p><p>460014, Оренбург, ул. Советская, 6</p></bio><bio xml:lang="en"><p>Zinaida A. Veterkova, Cand. of Sci. (Med.), Associate Professor of the Pediatrics Department</p><p>460014,  Orenburg, Sovetskaya str., 6</p></bio><email xlink:type="simple">zina76@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Усенкова</surname><given-names>Н. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Usenkova</surname><given-names>N. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Усенкова Наталья Николаевна, заведующая педиатрическим отделением</p><p>460006, Оренбург, ул. Гаранькина, 22</p></bio><bio xml:lang="en"><p>Natalya N. Usenkova, Head of the Pediatrics Department</p><p>22 Garankina str., Orenburg, 460006</p></bio><email xlink:type="simple">usenkova72@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Геворкян</surname><given-names>Д. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Gevorkyan</surname><given-names>D. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Геворкян Диана Вачагановна, заведующая отделением анестезиологии-реанимации</p><p>460006, Оренбург, ул. Гаранькина, 22</p></bio><bio xml:lang="en"><p>Diana V. Gevorkyan, Head of the Department of Anesthesiology and Reanimatology</p><p>22 Garankina str., Orenburg, Russia, 460006</p></bio><email xlink:type="simple">zav.aro@odkb56.ru</email><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Оренбургский государственный медицинский университет</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Orenburg State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Областная детская клиническая больница</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Regional Children's Clinical Hospital</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2026</year></pub-date><pub-date pub-type="epub"><day>01</day><month>07</month><year>2026</year></pub-date><volume>0</volume><issue>6</issue><fpage>57</fpage><lpage>63</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Рощупкин А.Н., Евстифеева Г.Ю., Данилова Е.И., Ветеркова З.А., Усенкова Н.Н., Геворкян Д.В., 2026</copyright-statement><copyright-year>2026</copyright-year><copyright-holder xml:lang="ru">Рощупкин А.Н., Евстифеева Г.Ю., Данилова Е.И., Ветеркова З.А., Усенкова Н.Н., Геворкян Д.В.</copyright-holder><copyright-holder xml:lang="en">Roschupkin A.N., Evstifeeva G.Y., Danilova E.I., Veterkova Z.A., Usenkova N.N., Gevorkyan D.V.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://journal.lvrach.ru/jour/article/view/1642">https://journal.lvrach.ru/jour/article/view/1642</self-uri><abstract><p>Введение. Синдром MIRAGE — это аббревиатура, составленная по заглавным буквам основных признаков редкого генетического заболевания, вызванного мутациями в генах NALCN и SAMD9: миелодисплазия, инфекция, задержка роста, гипоплазия надпочечников, генитальные фенотипы и энтеропатии – от англ. myelodysplasia (M), infection (I), growth restriction (R), adrenal hypoplasia (A), genital phenotypes (G) and enteropathy (E) [<xref ref-type="bibr" rid="cit1">1</xref>]. Это аутосомно-доминантное заболевание, обычно вызванное мутацией в генах, возникшей de novo. В настоящее время отсутствуют данные о долгосрочном прогнозе заболевания, но уже известно, что уровень смертности чрезвычайно высок и большинство пациентов умирают в детском возрасте. Основной характеристикой этого заболевания является гипоплазия органов из-за нарушений роста клеток. В настоящее время не совсем понятен точный механизм этого заболевания, предполагается, что эндосомальная дисфункция является возможным механизмом дефектов пролиферации клеток, наблюдаемых при этом заболевании.Цель работы. Целью публикации данного клинического случая явилась необходимость ознакомить врачей педиатрического профиля с особенностями клиники и диагностической тактики в отношении крайне редкого генетического синдрома.Материалы и методы. Ребенок в возрасте 1 года 5 мес (на момент постановки диагноза) с генетически подтвержденным синдромом MIRAGE и практически полной клинической картиной данного синдрома. Представлены подробный анамнез жизни ребенка, результаты клинического, инструментального и генетического обследования, а также особенности подбора терапии.Результаты. Приведенные в статье особенности анамнеза и клинической картины синдрома MIRAGE у пациента показывают, что необходимо проводить полный генетический анализ при неясной и нетипичной клинической картине, включающей поражение многих систем организма одновременно, для исключения самых редких генетических заболеваний.</p></abstract><trans-abstract xml:lang="en"><p>Background. DMIRAGE syndrome is an abbreviation which is derived from the capital letters of the main signs of a rare genetic disease caused by mutations in the NALCN and SAMD9 genes: myelodysplasia, infection, growth retardation, adrenal hypoplasia, genital phenotypes and enteropathy, or, in English, myelodysplasia (M), infection (I), growth restriction (R), adrenal hypoplasia (A), genital phenotypes (G), and enteropathy (E). It is an autosomal dominant disease, usually caused by a de novo mutation in genes. While there are currently no long-term outcome data, however, the mortality rate is known to be extremely high, with the majority of patients succumbing to the disease during childhood. This disease is primarily characterized by organ hypoplasia due to defective cell proliferation. The exact pathophysiologic mechanism of this syndrome has yet to be determined. Endosomal dysfunction is speculated to be a mechanism underlying the cell proliferation defects observed in this disease.Objective. The purpose of the publication of this clinical case was to familiarize pediatric doctors with the specifics of the clinic and diagnostic tactics in relation to an extremely rare genetic syndrome.Materials and methods. A child aged 1 year 5 months. (at the time of diagnosis) with a genetically confirmed diagnosis: MIRAGE syndrome. It has an almost complete clinical picture of this syndrome. A detailed history of the child's life, the results of clinical, instrumental and genetic examination, as well as the specifics of the selection of therapy are presented.Results. The features of the patient's medical history and clinical picture of MIRAGE syndrome stated in the article show that it is necessary to conduct a complete genetic analysis with an unclear and atypical clinical picture, including a simultaneous damage to many body systems, in order to exclude the rarest genetic diseases.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>дети</kwd><kwd>синдром MIRAGE</kwd><kwd>синдром циклической рвоты</kwd><kwd>первичный иммунодефицит</kwd></kwd-group><kwd-group xml:lang="en"><kwd>children</kwd><kwd>MIRAGE syndrome</kwd><kwd>"cyclic vomiting" syndrome</kwd><kwd>primary immunodeficiency</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Васильченко Г. С. 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