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Published on: September 20, 2018
ALDH18A1-related cutis laxa syndrome with cyclic vomiting
Fumihito Nozaki1, Takashi Kusunoki1, Nobuhiko Okamoto2
1Department of Pediatrics, Shiga Medical Center for Children, Shiga, Japan.
Insights
This study reports a rare case of ALDH18A1-related Cutis laxa (CL) in a 12-year-old boy, presenting with cyclic vomiting and specific amino acid deficiencies. This highlights a novel association between this connective tissue disorder and gastrointestinal symptoms.
Area of Science:
- Genetics
- Biochemistry
- Pediatrics
Background:
- Cutis laxa (CL) encompasses a group of connective tissue disorders characterized by skin laxity and potential organ involvement.
- ALDH18A1-related CL is a rare subtype with diverse clinical manifestations.
Abstract:
Cutis laxa (CL) syndromes are connective tissue disorders characterized by redundant, sagging, inelastic and wrinkled skin, with organ involvement. Here, we describe a patient with ALDH18A1-related CL who developed cyclic vomiting. The patient was a 12-year-old boy who presented with poor postnatal growth, hypotonia, short stature, joint hyperlaxity, microcephaly, strabismus, bilateral cataracts, facial dysmorphism and severe mental retardation. Bone radiographs showed osteopenia and osteoporosis, and magnetic resonance angiography showed marked kinking and tortuosity of the brain vessels. These findings were clinically compatible with ALDH18A1-related CL. Molecular analysis revealed a de novo heterozygous mutation (p.R138Q) in ALDH18A1. No mutations were found in PYCR1 gene. The patient developed cyclic vomiting with decreased blood levels of ornithine, citrulline, arginine and proline without hyperammonemia and other hypoaminoacidemias were also found. ALDH18A1 encodes Δ(1)-pyrroline-5-carboxylate synthase, which is related to the biosynthesis of ornithine, citrulline, arginine, and proline. Cyclic vomiting has never been reported in other ALDH18A1-related CL patients. This is the first case report of ALDH18A1-related CL with cyclic vomiting associated with amino acid abnormalities.
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