Use of dexamethasone in acute rhabdomyolysis in LPIN1 deficiency
Mehdi Yeganeh1, Kaitlin March1, Catherine Jones1
1Division of Biochemical Genetics, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver V6H 3N1, BC, Canada.
Insights
LPIN1 deficiency causes severe rhabdomyolysis in children. Intravenous dexamethasone effectively treated a toddler with LPIN1 deficiency, preventing complications and shortening hospital stays.
Area of Science:
- Biochemistry
- Genetics
- Pediatrics
Background:
- LPIN1 deficiency is an autosomal recessive disorder causing severe childhood rhabdomyolysis.
- LPIN1 influences inflammatory responses via PPARα and PGC-1α pathways.
- Corticosteroids like dexamethasone are potential treatments.
Introduction:
LPIN1 deficiency is an autosomal recessive form of early childhood recurrent severe rhabdomyolysis. Although not completely lucid yet, LPIN1 has been shown to modulate endosomal-related pro-inflammatory responses via peroxisome proliferator-activated receptor α (PPARα) and PPARγ coactivator 1α (PGC-1α). Treatment with anti-inflammatory agents such as dexamethasone has been proposed to improve the outcome.
Case:
We report a male toddler with recurrent episodes of complicated rhabdomyolysis, requiring prolonged intensive care unit admissions. Whole exome sequencing revealed a common homozygous 1.7 kb intragenic deletion in LPIN1. Despite optimal metabolic cares, the patient presented with an extremely high CK level where he benefited from intravenous dexamethasone (0.6 mg/Kg/day) for a period of 6 days.
Results:
Dexamethasone administration shortened the course of active rhabdomyolysis, intensive care admission and rehabilitation. It also prevented rhabdomyolysis-related complications such as kidney injury and compartment syndrome.
Conclusion:
Our patient showed a favorable response to parenteral dexamethasone, in addition to hyperhydration with IV fluids, sufficient calorie intake, and restricted dietary fat. The improvement with corticosteroids suggests an uncontrolled inflammatory response as the pathophysiology of LPIN1 deficiency.
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