Very-Late Onset Multiple Acyl-Coenzyme A Dehydrogenase Deficiency Associated With Sertraline Use: A Case Report

Area of Science:

• Biochemistry
• Neurology
• Genetics

Background:

• Multiple acyl-coenzyme A dehydrogenase deficiency (MADD) is a rare, treatable fatty acid oxidation disorder.
• Very-late-onset MADD often lacks genetic mutations and may be linked to sertraline exposure.

Purpose of the Study:

• To report a case of very late-onset MADD with negative genetic testing, potentially associated with sertraline use.
• To highlight the importance of considering MADD in patients on sertraline presenting with unexplained weakness.

Main Methods:

• A case report of a 75-year-old woman with progressive weakness, dysphagia, and dysarthria.
• Laboratory studies revealed elevated acylcarnitines; muscle biopsy showed lipid storage myopathy.
• Comprehensive genetic testing was negative; sertraline use was identified as a potential trigger.

Main Results:

• The patient presented with severe proximal weakness and neurological symptoms.
• Biochemical and histological findings were consistent with MADD.
• Discontinuation of sertraline and treatment with riboflavin, coenzyme Q10, and levocarnitine led to rapid clinical improvement.

Conclusions:

• This case supports the association between sertraline and very-late-onset MADD.
• Neurologists should suspect MADD in sertraline-treated patients with unexplained weakness.
• Early riboflavin treatment is critical for neurological recovery in MADD.