Late-Onset Lipid Storage Myopathy with Fatal Hepatosteatosis

Hepatosteatosis, a common condition, is increasing in prevalence. It is typically associated with diet, alcohol consumption and obesity. In some cases, a rare genetic disease may be the underlying defect. Lipid storage myopathy (LSM) is a genetic disease caused by lipid metabolism defects. LSM often affects the muscles, heart and liver. Coenzyme Q, riboflavin or carnitine replacement can be beneficial in some cases. We describe a patient who presented with liver failure and was unresponsive to treatment.

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Late-onset multiple acyl-CoA dehydrogenase deficiency mimicking myositis in an elderly patient: a case report

BMC Neurology ◽

10.1186/s12883-020-02010-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Yiming Zheng ◽

Yawen Zhao ◽

Wei Zhang ◽

Zhaoxia Wang ◽

Yun Yuan

Keyword(s):

Elderly Patient ◽

Muscle Weakness ◽

Dehydrogenase Deficiency ◽

Late Onset ◽

Lipid Storage ◽

Exercise Intolerance ◽

Lipid Storage Myopathy ◽

Case Presentation ◽

Acylcarnitine Profile ◽

Progressive Weakness

Abstract Background Late-onset multiple acyl-CoA dehydrogenase deficiency (MADD) is a rare and treatable inherited lipid storage myopathy. Here, we report an elderly patient with MADD mimicking myositis. Case presentation An 80-year-old woman had progressive weakness in her limbs, exercise intolerance, and no muscle pain for 3 months. The patient’s serum creatine kinase level was slightly elevated. The initial diagnosis was myositis. However, muscle biopsy showed many cytoplasmic vacuoles stained with oil red O, indicating the presence of lipid storage myopathy. The plasma acylcarnitine profile showed increased medium-chain and long-chain acylcarnitine species, consistent with the diagnosis of MADD. Riboflavin treatment dramatically improved muscle weakness. Conclusions MADD should be considered when evaluating elderly patients with subacute muscle weakness.

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Late onset form of lipid storage myopathy; 2 case reports

Journal of the Neurological Sciences ◽

10.1016/j.jns.2017.08.1976 ◽

2017 ◽

Vol 381 ◽

pp. 702

Author(s):

S. Okune ◽

A. Ishii ◽

N. Tozaka ◽

A. Shioya ◽

A. Tamaoka

Keyword(s):

Late Onset ◽

Case Reports ◽

Lipid Storage ◽

Lipid Storage Myopathy

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Late-onset riboflavin-responsive multiple acyl-CoA dehydrogenase deficiency (MADD): case reports and epidemiology of ETFDH gene mutations

BMC Neurology ◽

10.1186/s12883-019-1562-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Wei Chen ◽

Youqiao Zhang ◽

Yifeng Ni ◽

Shaoyu Cai ◽

Xin Zheng ◽

...

Keyword(s):

Dehydrogenase Deficiency ◽

Late Onset ◽

Southern China ◽

Case Reports ◽

Lipid Storage ◽

Chinese Family ◽

Homozygous Mutation ◽

Muscle Enzymes ◽

Lipid Storage Myopathy ◽

Southern Min

Abstract Background Multiple acyl-CoA dehydrogenase deficiency (MADD) is a riboflavin-responsive lipid-storage myopathy caused by mutations in the EFTA, EFTB or ETFDH genes. We report a Chinese family of Southern Min origin with two affected siblings with late-onset riboflavin-responsive MADD due to a homozygous c.250G > A EFTDH mutation and review the genetic epidemiology of the c.250G > A mutation. Case presentation Both siblings presented with exercise-induced myalgia, progressive proximal muscle weakness and high levels of serum muscle enzymes and were initially diagnosed as polymyositis after a muscle biopsy. A repeat biopsy in one sibling subsequently showed features of lipid storage myopathy and genetic analysis identified a homozygous mutation (c.250G > A) in the ETFDH gene in both siblings and carriage of the same mutation by both parents. Glucocorticoid therapy led to improvement in muscle enzyme levels, but little change in muscle symptoms, and only after treatment with riboflavin was there marked improvement in exercise tolerance and muscle strength. The frequency and geographic distribution of the c.250G > A mutation were determined from a literature search for all previously reported cases of MADD with documented mutations. Our study found the c.250G > A mutation is the most common EFTDH mutation in riboflavin-responsive MADD (RR-MADD) and is most prevalent in China and South-East Asia where its epidemiology correlates with the distribution and migration patterns of the southern Min population in Southern China and neighbouring countries. Conclusions Mutations in ETFDH should be screened for in individuals with lipid-storage myopathy to identify patients who are responsive to riboflavin. The c.250G > A mutation should be suspected particularly in individuals of southern Min Chinese background.

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