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Published on: September 15, 2018
Progressive familial intrahepatic cholestasis type 4 in an Indian child: presentation, initial course and novel
Nida Mirza1, Ravi Bharadwaj2, Smita Malhotra2
1Pediatric Gasteroenterology, Indraprastha Apollo Hospital, New Delhi, India nydamirza.1@gmail.com.
Insights
A novel mutation in the TJP2 gene was identified in a young patient with a history of cholestatic liver disease. This genetic finding confirmed the diagnosis of progressive familial intrahepatic cholestasis type 4.
Area of Science:
- Genetics
- Hepatology
- Pediatric Gastroenterology
Background:
- Progressive familial intrahepatic cholestasis (PFIC) encompasses genetic disorders affecting bile flow.
- TJP2 gene mutations are a known cause of PFIC, but novel mutations continue to be identified.
Abstract:
A 15-year-old boy who had a history of on and off pruritus and jaundice since many years found to have a novel mutation in TJP2 gene. On examination, he had clubbing, splenomegaly, grade 3 oesophageal varices and short stature. Investigation revealed direct hyperbirubinemia with elevated liver enzymes with normal gamma-glutamyl transferase (GGT). Antinuclear antibody (ANA), smooth muscle antibody (SMA) anti-liver kidney microsomal (anti-LKM) and viral markers for hepatitis were negative. However, IgG was elevated and anti-smooth muscle antibody (ASMA) was weekly positive (1:20). He was also given a trial of steroid and azathioprine for 1 year on the basis of liver biopsy findings, raised IgG and positive ASMA but finding no improvement stopped. Genetic testing by next-generation sequencing found a novel compound heterozygous missense variation in exon 17 of the TJP2 gene confirming progressive familial intrahepatic cholestasis type 4 as the aetiology of cholestatic liver disease.
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