A rare presentation of a rare metabolic disorder – Multiple Acyl CoA dehydrogenase deficiency presenting as rhabdomyolysis and renal failure

Multiple acyl-CoA dehydrogenase deficiency (MADD) is a rare metabolic disorder of oxidation of amino acids and fatty acids with an autosomal recessive inheritance. Patients usually present symptoms of MADD in the neonatal period, though it can also be diagnosed in the late adulthood. We present a 36-year-old male with MADD who had sensory axonal neuropathy, rhabdomyolysis metabolic acidosis, lactic acidosis, hypoglycemia and low ketone bodies and renal failure. Early diagnosis and prompt management with carnitine and riboflavin supplements can help in better management of this rare metabolic disorder.

Metabole acidose met verhoogde anion gap ten gevolge van 5-oxoprolinurie bij gelijktijdig gebruik van acetaminofen en flucloxacilline

Metabolic acidosis with increased anion gap due to 5-oxoprolinuria with concomitant use of acetaminophen and flucloxacillin 5-oxoprolinuria is a relatively rare metabolic disorder in which there is accumulation of 5-oxoproline leading to a high anion gap metabolic acidosis. The acquired form is usually caused by simultaneous use of acetaminophen (also known as paracetamol) and flucloxacillin, which is not uncommon. The exact incidence and prevalence of the acquired form are not known. This disorder is most likely under-reported as the test used for diagnosis is not always performed nor easy accessible. Diagnosing 5-oxoprolinuria requires testing urine or serum of a patient for the presence of organic acids, which are highly elevated in 5-oxoprolinuria. Due to the relative rareness of the disorder, cases are easily missed. 5-oxoprolinuria should always be suspected in a patient with unexplained high anion gap metabolic acidosis and/or therapy with flucloxacillin with or without the concomitant use of acetaminophen. Treating 5-oxoprolinuria is straightforward and consists of stopping the offending drug(s) which mostly leads to a spontaneous recovery. Treatment with sodium bicarbonate and/or N-acetylcysteine are also described in the literature, but at present there is not sufficient evidence supporting their use.

Hypoparathyroidism and Fahr’s syndrome: case series

Hypoparathyroidism (HP) is a rare metabolic disorder and causes hypocalcemia because parathyroid hormone secretion is inadequate to mobilize calcium from bone and reabsorb calcium from kidney and gut. Anterior neck surgery is the most common cause of acquired HP and autoimmune HP is the next most common form in adults. The duration, severity, and rate of development of hypocalcemia determine the clinical presentation. A variety of organs can be affected by calcification, more frequently kidneys, but also joints, eyes, skin, vasculature, and other organ systems and, although rarely seen, intracerebral calcifications. Case series: We report four cases of bilateral basal ganglia calcifications (BGC) also known as Fahr’s syndrome related to hypoparathyroidism. Discussion: Fahr’s syndrome is characterized by bilateral symmetrical calcification of areas of the brain that control movements including basal ganglia, thalamus, and others; it is a rare inherited or sporadic neurological disorder with a prevalence of less than 1/1.000.000. Main symptoms related to bilateral BGC include extra-pyramidal and cerebellar disorders, cognitive impairment, epileptic seizures, and psychiatric changes. BGC has been established as a possible outcome of HP. Its prevalence, demonstrated in the HP cohorts, varied significantly from 12 up to 74%. Currently, computed tomography (CT) is the most valuable method for diagnosis. The treatment include symptomatic support and identification of causes, but there is no specific treatment limiting the progression of calcification in the basal ganglia. Especially in HP, an early treatment can prevent calcification and neurophysiological disorders.

Intrathecal baclofen therapy for Lesch-Nyhan disease: illustrative case

BACKGROUNDLesch-Nyhan disease (LND) is a very rare metabolic disorder involving the purine salvage pathway. LND manifests hyperuricemia, self-mutilation, cognitive impairment, and movement disorders such as spasticity and dystonia, whose control is difficult pharmaceutically.OBSERVATIONSIntrathecal baclofen (ITB) therapy was received by a 22-year-old male for generalized dystonia. His paroxysmal abnormal dystonic posturing reduced after surgery, making the task of caregivers easier despite the unchanged assignment on the dystonia scale during a follow-up period of 4 years.LESSONSITB may be a safe and feasible option for dystonic symptoms and difficulty with nursing care in patients with LND.

Late-onset multiple acyl-CoA dehydrogenase deficiency with breast cancer

Background Multiple acyl-CoA dehydrogenase deficiency (MAAD) is a rare metabolic disorder resulting from an abnormality in fatty acid oxidation. There are three types of presentations: neonatal onset with or without congenital anomalies and the late-onset type. There is much clinical heterogeneity in the presentation of late-onset variants; hence, the diagnosis is often delayed or missed. Case presentation Here, we report the successful management of a 41-year-old female with late-onset MAAD due to mutation in the ETFDH gene who presented with carcinoma of the breast. Chemotherapy was challenging because there were no previous reports regarding the treatment of such cases. Conclusion The diagnosis was made based on metabolic workup and gene mutation analysis. Unplanned surgery and chemotherapy can be fatal in these patients due to metabolic complications. With proper precautions and monitoring, the patient tolerated surgery and chemotherapy without any complications.

Family Trimethylaminury Associated with Hereditary Angioedema

There are patients who complain of giving off a fishy smell through the skin and sweat, which can be a cause of stress in which the doctor often fails to accept this situation, or even the patient or his family members are ashamed of communicate these symptoms, causing their isolation. Trimethylaminuria, also called fish smell syndrome or fish smell syndrome, is a very rare metabolic disorder that presents an autosomal recessive inheritance pattern, causing an alteration in the function of the enzyme flavinmonooxygenase 3 (FMO3 ). On the other hand, the presence of alterations in the inflammatory chain that governs the complement cascade is responsible for clinical situations that require an accurate diagnosis, such as Hereditary Angioedema, since their evolution can be the origin of clinical complications, serious times We present a case of family Trimethylaminuria in which the affected are two brothers of 2 and 6 years, and whose diagnosis could be obtained since the male patient presented an outbreak of inflammation of the face finally identified as Hereditary Angioedema.

A Newborn Infant With Poor Feeding: Non-ketotic Hyperglycinemia

Non-ketotic hyperglycinemia (NKH) is a rare autosomal recessive disorder affecting glycine metabolism that is a rare metabolic disorder in infants. The clinical manifestations of poor sucking, hypotonicity, lethargy, hiccups, and seizures develop within six hours to eight days of the birth of an otherwise healthy newborn. The present study introduced a newborn girl with poor feeding and hypotonia in the first day after birth with NKH. In addition, the patient was evaluated regarding hypotonia and poor feeding. The neonatal-onset NKH was diagnosed based on a markedly elevated cerebrospinal fluid/plasma glycine ratio of 0.32 and confirmed by the genetic test. It is extremely rare that NKH is manifested with poor feeding and hypotonia thus considering this diagnosis in infants with poor feeding and hypotonia is highly important.

Cerebral salt wasting in a patient with myeloproliferative neoplasm

Background Cerebral salt wasting (CSW) is a rare metabolic disorder with severe hyponatremia and volume depletion usually caused by brain injury like trauma, cerebral lesion, tumor or a cerebral hematoma. The renal function is normal with excretion of very high amounts of sodium in the urine. Diagnosis is made by excluding other reasons for hyponatremia, mainly the syndrome of inappropriate antidiuretic hormone secretion (SIADH).