ROSAH syndrome lacking splenomegaly and complete anhidrosis

ROSAH (retinal dystrophy, optic nerve oedema, splenomegaly, anhidrosis and headache) syndrome is a rare multisystem autoinflammatory disorder caused by heterozygous gain-of-function mutations in ALPK1 Initially characterised by these features, its clinical spectrum extends beyond the acronym. We report the first genetically confirmed case in Latin America. The proband, in her mid-20s, presented with progressive retinal dystrophy leading to vision loss, xerostomia, short dental roots, recurrent low-grade fevers and elevated C-reactive protein. Notably, she lacked splenomegaly and anhidrosis; instead, mild hypohidrosis was identified retrospectively following genetic confirmation of the ALPK1 p.Thr237Met variant. Her mother, carrying the same variant, exhibited blindness from advanced retinal degeneration, severe arthritis, recurrent fevers, hypohidrosis and inability to lactate. This family illustrates the variable expressivity of ROSAH syndrome and underscores that absence of classic features should not exclude the diagnosis. Early recognition and genetic testing are essential, as timely initiation of immunomodulatory therapy may mitigate the risk of loss of vision.