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Rectal Organoid Morphology Analysis ROMA: A Diagnostic Assay in Cystic Fibrosis
Published on: June 10, 2022
[Pseudo-Bartter syndrome as manifestation of cystic fibrosis with DF508 mutation]
María de Jesús Galaviz-Ballesteros1, Carlos Patricio Acosta-Rodríguez-Bueno1, Alejandra Consuelo-Sánchez1
1Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Ciudad de México, México.
Insights
Pseudo Bartter syndrome (PBS), a condition causing electrolyte imbalances, can occur in infants with cystic fibrosis (CF). This case highlights the importance of considering CF in young children presenting with PBS symptoms.
Area of Science:
- Pediatric Nephrology
- Genetic Disorders
- Metabolic Alkalosis
Context:
- Pseudo Bartter syndrome (PBS) is characterized by hypokalemic, hypochloremic metabolic alkalosis without renal tubular pathology.
- Cystic Fibrosis (CF) is a genetic disorder that can lead to electrolyte abnormalities, including PBS, particularly in children.
- Infants with CF are susceptible to dehydration, vomiting, chronic cough, polyuria, malnutrition, and acute renal failure.
Purpose:
- To report a case of Pseudo Bartter syndrome (PBS) in an infant with Cystic Fibrosis (CF).
- To emphasize the diagnostic considerations for PBS in young children.
- To highlight the association between CF and PBS, especially in infants under two years old.
Summary:
- A 5-month-old female infant presented with dehydration, vomiting, chronic cough, polyuria, malnutrition, metabolic alkalosis, hypokalemia, hyponatremia, hypochloremia, and acute renal failure.
- Diagnostic workup excluded other causes of chronic cough and confirmed PBS due to electrolyte imbalances. Cystic Fibrosis was confirmed via sweat electrolyte testing and molecular analysis of the delta F508 mutation.
- This case illustrates a rare presentation of CF mimicking PBS, underscoring the need for early diagnosis and management.
Impact:
- This case contributes to the understanding of rare presentations of Cystic Fibrosis.
- It emphasizes the importance of considering PBS in the differential diagnosis of hyponatremic dehydration with metabolic alkalosis in infants.
- Early recognition of CF in infants presenting with PBS can prevent severe complications and improve outcomes.
Background:
Pseudo Bartter syndrome (PBS) is defined as hypokalaemic hypochloraemic metabolic alkalosis in the absence of renal tubular pathology. Children with cystic fibrosis (CF) are at risk of developing electrolyte abnormalities and even PBS may occur.
Case Report:
5 months old female infant with a history of two events of dehydration with vomit, refusal to eat, chronic cough, polyuria, malnutrition, metabolic alkalosis, hypokalemia, hyponatremia, hypochloremia and acute renal failure. Chronic cough study was performed, discarding pulmonary tuberculosis, gastroesophageal reflux disease and impaired swallowing. PBS was diagnosed due to hypokalaemic hypochloraemic metabolic alkalosis in the absence of renal tubular pathology. CF was corroborated by electrolytes in sweat and through molecular analysis of the delta F508 mutation. This is one of the few reported cases linking PBS and this mutation.
Conclusions:
In patients with hyponatremic dehydration episodes with hypokalaemic hypochloraemic metabolic alkalosis, PBS should be considered as differential diagnosis. CF could be presented as PBS, mainly in patients younger than 2 years.
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