Association of anti-nuclesome and anti C1q antibodies with lupus nephritis in an Egyptian cohort of patients with systemic lupus erythematosus

Abstract Introduction: Anti-nucleosome and anti-C1q antibodies demonstrated an association with the development of glomerulonephritis in systemic lupus erythematosus (SLE). Some investigators have proposed that monitoring anti- C1q and anti-nucleosome antibodies might be valuable for making predictions about lupus nephritis (LN) and assessment of disease activity as a non-invasive biological marker of renal disease. Objectives: The current study was proposed to investigate the presence of anti-C1q and anti-nucleosome antibodies in the sera of Egyptian patients with SLE and their association with LN. Methods: Eighty patients with SLE were included. Patients were classified into, a LN group including 40 cases with active LN (based on the results of renal biopsy and renal SLEDAI≥4) and a non renal SLE group including 40 patients (with no clinical or laboratory evidence of renal involvement that were attributed in the past or present to SLE). They were subjected to full medical history taking, clinical examination, routine laboratory investigations, measurement of antinuclear antibody (ANA), anti-ds DNA, anti-C1q & anti-nucleosome antibodies. Results: Anti-C1q antibody showed a statistically significant association with the presence of vasculitis and nephritis while anti-nucleosome antibody didn't show a significant association with the presence of any clinical features. Double positivity of anti-nucleosome and anti-C1q antibodies showed a statistically significant association with the presence of vasculitis and photosensitivity, high ECLAM score, elevated ESR, low serum albumin and low C3 levels. Conclusion: Serum anti-C1q antibody has a significant association with LN while double positive antibodies have a significant association with vasculitis and low C3 levels in Egyptian patients with SLE.

Consenso argentino sobre enfermedad de Pompe de inicio tardío / Argentine consensus on late-onset Pompe's disease

La enfermedad de Pompe (EP) es un desorden metabólico autosómico recesivo infrecuente, producido por la ausencia o deficiencia de la enzima lisosomal alfa-glucosidasa ácida en los tejidos de los individuos afectados. Se considera enfermedad de Pompe de inicio tardío (EPIT) en aquellos individuos de más de un año de edad al comienzo de los síntomas. El objetivo del presente consenso es el de actualizar las pautas y recomendaciones para un correcto tratamiento de los pacientes con EPIT, tomando como referencia los lineamientos del Consenso Argentino para el diagnóstico, seguimiento y tratamiento de la enfermedad de Pompe publicado en el año 2013. Se organizó un consenso que reunió profesionales con experiencia en la EP en las áreas de clínica médica, diagnóstico de laboratorio, neuropatología, neumonología, nutrición, neurología, enfermedades metabólicas, enfermedades neuromusculares y rehabilitación. Se realizó una actualización de la bibliografía sobre EPIT, con especial atención en las publicaciones relevantes de los últimos cuatro años. Los términos finales del documento fueron consensuados por todo el grupo de trabajo. Cada participante proporcionó su declaración de conflicto de intereses. El resultado es una actualización del último Consenso Argentino para la EP, con particular enfoque en su forma de comienzo tardío. Tratándose de una afección infrecuente, en la que los datos disponibles son limitados, las presentes recomendaciones deben ser consideradas como opinión de expertos.

Pompe's disease (PD) is an infrequent metabolic autosomic recessive disorder produced by the lack or deficiency of the acid alpha-glucosidase lysosomal enzyme in tissues of involved individuals. Delayed-onset PD is considered whenever symptoms onset start after one year of age. We present an update of the recommendations for the management of delayed-onset PD, taking as reference the guidelines from the Argentine Consensus for diagnosis, treatment and follow-up of PD published in 2013. The present consensus gathered several experts in PD in the areas of internal medicine, laboratory diagnosis, neuropathology, pulmonology, nutrition, neurology, metabolic and neuromuscular disorders as well as rehabilitation to perform an update of the literature of delayed-onset PD, with special attention on relevant information published within the last 4 years. The entire working group approved the final version of the consensus. Each participant provided a declaration of conflict of interest. As a result, it is an update of the previous Argentine PD Consensus with focus on the delayed-onset presentation of the disease. Being such infrequent disorder, available data were rather limited and thus, the recommendations represent expert opinions.

Late-onset Pompe disease: what is the prevalence of limb-girdle muscular weakness presentation? / Doença de Pompe de início tardio: qual é a prevalência na apresentação de fraqueza muscular de cinturas?

ABSTRACT Pompe disease is an inherited disease caused by acid alpha-glucosidase (GAA) deficiency. A single center observational study aimed at assessing the prevalence of late-onset Pompe disease in a high-risk Brazilian population, using the dried blood spot test to detect GAA deficiency as a main screening tool. Dried blood spots were collected for GAA activity assay from 24 patients with "unexplained" limb-girdle muscular weakness without vacuolar myopathy in their muscle biopsy. Samples with reduced enzyme activity were also investigated for GAA gene mutations. Of the 24 patients with dried blood spots, one patient (4.2%) showed low GAA enzyme activity (NaG/AaGIA: 40.42; %INH: 87.22%). In this patient, genetic analysis confirmed two heterozygous mutations in the GAA gene (c.-32-13T>G/p.Arg854Ter). Our data confirm that clinicians should look for late-onset Pompe disease in patients whose clinical manifestation is an "unexplained" limb-girdle weakness even without vacuolar myopathy in muscle biopsy.

RESUMO A doença de Pompe é uma doença hereditária causada pela deficiência da enzima alfa-glicosidase ácida (GAA). Estudo observacional foi realizado, em um único centro, para determinar a prevalência da doença de Pompe de início tardio (LOPD) em uma população brasileira de alto risco, usando teste em gota seca (DBS) como ferramenta principal de triagem para detectar a deficiência da GAA. DBS foi coletado para avaliar a atividade da GAA em 24 pacientes com fraqueza muscular de cinturas "não explicada" sem miopatia vacuolar na biópsia muscular. As amostras com atividade enzimática reduzida foram também submetidas a análise de mutações no gene GAA. Dos 24 pacientes com DBS, baixa atividade da enzima GAA (NaG/AaGIA: 40.42; %INH: 87.22%) foi encontrada em um paciente (4.2%). Nessa paciente, a análise genética confirmou duas mutações em heterozigose composta no gene GAA (c.-32-13T > G/p.Arg854Ter). Nossos resultados confirmam que LOPD deve ser investigada quando a manifestação clínica é uma fraqueza muscular de cinturas "não explicada", mesmo na ausência de miopatia vacuolar na biópsia muscular.

Respiratory manifestations in late-onset Pompe disease: a case series conducted in Brazil / Manifestações respiratórias na doença de Pompe de início tardio: uma série de casos no Brasil

ABSTRACT Objective: To describe respiratory function in a series of patients with late-onset Pompe disease after the definitive diagnosis and before enzyme replacement therapy. Methods: This was a cross-sectional study involving patients with a definitive molecular diagnosis of late-onset Pompe disease. The data analyzed included age at symptom onset; age at definitive diagnosis; type of initial symptoms; time from symptom onset to diagnosis; FVC in the sitting and supine positions; six-minute walk distance; and locomotor ability. Analyses were carried out using frequencies, medians, minimum values, and maximum values. Results: Six patients were included in the study. The median age at symptom onset was 15 years (range, 13-50 years), and the median age at diagnosis was 39.5 years (range, 10-64 years). The median time from symptom onset to diagnosis was 8 years (range, 0-45 years). In all cases, the initial manifestation of the disease had been motor weakness. The median FVC in percentage of the predicted value (FVC%) in the sitting and supine positions was 71.0% (range, 22.9-104.6%) and 58.0% (range, 10.9-106.9%), respectively. The median ΔFVC% was 24.5% (range, −4.59 to 52.40%).The median six-minute walk distance was 391.7 m (range, 97-702 m) . Conclusions: In this case series, the time from symptom onset to diagnosis was long. Although respiratory signs or symptoms were not the initial manifestations of the disease, 66.7% of the patients showed reduced FVC% in the sitting and supine positions at diagnosis.

RESUMO Objetivo: Descrever a função respiratória em uma série de pacientes com doença de Pompe de início tardio após o diagnóstico definitivo e antes do início do tratamento através de terapia de reposição enzimática. Métodos: Estudo transversal em pacientes com diagnóstico molecular de doença de Pompe de início tardio. As informações analisadas incluíram idade ao início dos sintomas e ao diagnóstico, tipo de sintoma inicial, tempo entre início dos sintomas e diagnóstico, CVF em posição sentada e supina, distância percorrida no teste de caminhada de seis minutos e capacidade de locomoção. Análises por frequência, mediana, valor mínimo e valor máximo foram realizadas. Resultados: Foram incluídos seis pacientes no estudo. A mediana de idade ao início dos sintomas foi de 15 anos (variação, 13-50 anos) e a de idade ao diagnóstico foi de 39,5 anos (variação, 10-63 anos). A mediana de tempo entre o início dos sintomas e a confirmação diagnóstica foi de 8 anos (variação, 0-45 anos). A manifestação inicial da doença foi de sintomas motores de fraqueza muscular em todos os casos. As medianas da CVF em porcentagem do previsto (CVF%) em posição sentada, em supino e ΔCVF% foram de, respectivamente, 71,0% (variação, 22,9-104,6%), 58,0% (variação, 10,9-106,9%) e 24,5% (−4,59 a 52,40%). A mediana da distância percorrida no teste de caminhada de seis minutos foi de 391,7 m (variação, 97-702 m) . Conclusões: Nesta série, o tempo entre o início dos sintomas e o diagnóstico foi longo. A manifestação inicial da doença não foi de sinais ou sintomas respiratórios, embora 66,7% dos pacientes apresentassem redução da CVF% em posição sentada e em supino no momento do diagnóstico.

Diagnóstico y tratamiento de la enfermedad de Pompe / Diagnosis and treatment of Pompe disease

INTRODUCCIÓN: la enfermedad de Pompe es una glucogenosis tipo II con patrón de herencia autosómico recesivo, causada por la deficiencia de la enzima alfa-glucosidasa ácida, que provoca acúmulo de glucógeno en los lisosomas de los macrófagos. El gen está mapeado en el cromosoma 17q25, y han sido detectadas más de 460 mutaciones. Están descritas 3 formas clínicas de la enfermedad, que incluyen, la variedad infantil, la juvenil y la tardía. La variedad infantil se caracteriza por miocardiopatía hipertrófica o infiltrativa, hipotonía, hepatomegalia y macroglosia. En la variedad juvenil hay fiebre recurrente, infecciones respiratorias a repetición y discapacidad motora progresiva. La terapia de reemplazo enzimático modifica el curso clínico de la enfermedad. PRESENTACIÓN DE CASOS: se presentan los elementos al diagnóstico de 4 casos con esta enfermedad, 3 de ellos con la variedad infantil y uno con la variedad juvenil, y se discuten los resultados de estudio molecular. Se informa la evolución clínica de 2 de ellos, luego de 6 meses y un año de tratamiento con la terapia de reemplazo enzimático con alfa-glucosidasa ácida (myozyme), lo que ha llevado a la mejoría de parámetros bioquímicos y clínicos en ambos casos. CONCLUSIONES: en pacientes con enfermedad de Pompe la cuidadosa evaluación clínica para diagnosticar precozmente la enfermedad y el comienzo de la terapia de reemplazo enzimático contribuyen a mejorar las funciones musculares, motoras y cardiovasculares, lo cual impacta en la supervivencia y calidad de vida de estos niños(AU)

INTRODUCTION: Pompe disease is a type II glycogenosis with recessive autosomal inheritance pattern, which is caused by the acid alpha-glucosidase enzyme that brings about buildup of glycogen in macrophage lysosomes. The gene is already mapped in Chromosome 17q25 and has been so far detected over 460 mutations. Three clinical forms of disease were described, including infantile, juvenile and late-onset varieties. The infantile variety is characterized by hpertrophic or infiltratin myocardiopathy, hypotonia, hepatomegaly and macroglossia. The juvenile type comprises recurrent fever, repeated respiratory infections and progressive motor disability. Enzyme replacement therapy changes the clinical course of disease. CASE PRESENTATION: the elements for diagnosis of 4 cases were submitted, 3 of them with infantile form and one with juvenile one. The results of the molecular study were discussed. The clinical progress of 2 of them after 6 monts and one year of treatment with the enzymatic replacement therapy using acid alpha-glucosidase (myozyme), which led to improvement of biochemical and clinical parameters in both cases. CONCLUSIONS: careful clinical assessment of patients with Pompe disease to early diagnose it and the onset of the enzyme replacement therapy help to improve muscle, motor and cardiovascular functions, which has an impact on survival and quality of life of these children(AU)

Guidelines for the diagnosis, treatment and clinical monitoring of patients with juvenile and adult Pompe disease / Diretriz para o diagnóstico, tratamento e acompanhamento clínico de pacientes com doença de Pompe juvenil e do adulto

ABSTRACT Pompe disease (PD) is a potentially lethal illness involving irreversible muscle damage resulting from glycogen storage in muscle fiber and activation of autophagic pathways. A promising therapeutic perspective for PD is enzyme replacement therapy (ERT) with the human recombinant enzyme acid alpha-glucosidase (Myozyme®). The need to organize a diagnostic flowchart, systematize clinical follow-up, and establish new therapeutic recommendations has become vital, as ERT ensures greater patient longevity. A task force of experienced clinicians outlined a protocol for diagnosis, monitoring, treatment, genetic counseling, and rehabilitation for PD patients. The study was conducted under the coordination of REBREPOM, the Brazilian Network for Studies of PD. The meeting of these experts took place in October 2013, at L’Hotel Port Bay in São Paulo, Brazil. In August 2014, the text was reassessed and updated. Given the rarity of PD and limited high-impact publications, experts submitted their views.

RESUMO A doença de Pompe (DP) é uma doença grave, potencialmente letal, devida ao depósito de glicogênio na fibra muscular e ativação de vias autofágicas. Tratamento promissor para a DP é a reposição enzimática com a enzima recombinante humana alfa-glicosidase ácida (rhAGA -Myozyme®). A necessidade de organizar uma propedêutica diagnóstica, sistematizar o seguimento clínico e sedimentar as novas recomendações terapêuticas tornaram-se vitais à medida que o tratamento permite uma maior longevidade aos pacientes. Uma força-tarefa de clínicos experientes no manejo da DP foi constituída para elaborar um protocolo para o diagnóstico, acompanhamento clínico, tratamento, aconselhamento genético, entre outras considerações voltadas ao paciente adulto. O estudo foi realizado sob a coordenação da Rede Brasileira de Estudos da Doença de Pompe (REBREPOM). Diante da raridade da DP e escassez de trabalhos de alto impacto de evidência científica, os especialistas emitiram suas opiniões.

Informe de evaluación rápida de tecnología sobre seguridad y efectividad del uso de Alfaglucosidasa en el tratamiento de pacientes con enfermedad de pompe infantil / Rapid evaluation report of technology on the safety and effectiveness of the use of Alfaglucosidasa in the treatment of patients with infantile pompe disease

Si bien utilizar alfaglucosidasa genera beneficios a los pacientes, estos beneficios no curan la enfermedad. Se demostró mejoría en habilidades motoras, disminución de cardiomegalia, mejora en función cardíaca, mejora anormalidad de conducción, mejora cardiopatía. De la misma forma, reduce el riesgo de ventilación invasiva y de cualquier ventilación, reduce el riesgo de morir y mejora la sobrevida. Con respecto a la seguridad, se reportan reacciones asociadas a la infusión y los efectos adversos son mínimos y pueden ser manejados. Se recomienda cubrir con generación de evidencia.(AU)

Carcinoma neuroendocrino de timo con enfermedad de pompe del adulto / Thymic neuroendocrine carcinoma with Pompe's disease of the adult

La enfermedad de Pompe (glucogenosis tipo II) es una enfermedad de depósito lisosomal, autosómica recesiva causada por una deficiencia de ácido alfa-glucosidasa. Los tumores neuroendocrinos tímicos son neoplasias primarias con diferenciación neuroendocrina que generalmente se presentan como una masa en el mediastino anterior. Ambas enfermedades se consideran raras en sí mismas. En nuestro conocimiento, la enfermedad de Pompe y un tumor neuroendocrino del timo en el mismo paciente no ha sido antes comunicada. No pudimos encontrar la plausibilidad biológica entre ambas enfermedades. Se necesitan más estudios para confirmar el hallazgo y para aumentar aún más nuestra comprensión de esta asociación. Los datos clínicos de los estudios epidemiológicos, los informes de casos, las series de casos y los pequeños ensayos clínicos abiertos o controlados pueden definir tanto la plausibilidad clínica como la causalidad entre las dos enfermedades.

Pompe disease (glycogenosis type II) is an inherited autosomal recessive lysosomal storage disease caused by a deficiency of acid alpha-glucosidase. Thymic neuroendocrine tumors, are primary thymic neoplasms with neuroendocrine differentiation that generally present as a mass within the anterior mediastinum. Both diseases are considered rare. To our knowledge the co-existence of Pompe disease and thymic neuroendocrine tumor in the same patient has not been previously reported. We could not find biological plausibility between both diseases. Further studies are needed to confirm the finding and to further increase our understanding of this association. Clinical data from epidemiological studies, case reports, case series and small formal open or controlled clinical trials may define both clinical plausibility and causality between the two conditions.

Homozygotic intronic GAA mutation in three siblings with late-onset Pompe's disease / Mutação homozigótica intrônica no gene GAA em três irmãos com doença de Pompe de início tardio

Pompe's disease (PD) is a metabolic myopathy caused by the accumulation of lysosomal glycogen, secondary to acid α-glucosidase (GAA) enzyme deficiency. Childhood and late-onset forms are described, differing by the age of onset and symptoms. In this study were analyzed affected siblings with Pompe's disease (PD) and their distinct clinical and pathological presentations. METHOD: Diagnosis was performed by the clinical presentation of limb-girdle dystrophies and respiratory compromise. Confirmatory diagnoses were conducted by muscle biopsy, GAA activity measurement and by GAA gene genotyping. RESULTS: The findings suggested muscular involvement due to GAA deficiency. GAA genotyping showed they are homozygous for the c.-32-3C>A mutation. CONCLUSION: Herein we reported a family where three out of five siblings were diagnosed with late-onset PD, although it is a rare metabolic disease inherited in an autossomal recessive manner. We emphasize the importance of including this presentation within the differential diagnoses of the limb-girdle dystrophies once enzyme replacement therapy is available.

A doença de Pompe (DP) é uma miopatia originada do acúmulo lisossomal de glicogênio, devido à deficiência da enzima α-glicosidase ácida (GAA), sendo descritas formas de inicio precoce e tardio. Neste estudo analisamos retrospectivamente o perfil clinico e patológico de 3 irmãos portadores de doença de Pompe de inicio tardio. MÉTODO: O diagnóstico foi realizado mediante apresentação clinica de distrofia de cinturas associado a comprometimento respiratório, sendo confirmado por biópsia muscular e análise da atividade e genotipagem da GAA. RESULTADOS: Os exames clínicos e laboratoriais demonstram envolvimento muscular devido à deficiência da GAA, com uma mutação c.-32-3C>A em homozigose. CONCLUSÃO: Relatamos os aspectos clínicos e laboratoriais de 3 irmãos afetados por doença de Pompe de início tardio. Enfatizamos a importância de incluir esta patologia no diagnóstico diferencial das distrofias de cinturas, uma vez que para esta patologia específica existe a possibilidade terapêutica através de reposição enzimática.

Anesthesia management in an 11-month old infant with pompe disease

Pompe disease is a glycogen storage disease [GSD] type II. Infantile-onset Pompe disease is fatal presenting with cardiac and skeletal myopathies and has an autosomal recessive pattern of inheritance with the prevalence rate of 1 in 40,000 live births [1]. Its common symptoms include cardiomegaly, hypotonia, failure to thrive [FTT] and hepatomegaly [1].The patient was a 4 kg, 11-month-old infant with the history of jaundice and recurrent seizures under treatment with phenytoin [15 mg/day] and phenobarbital [15 mg/day]. He was hypotonic, cachectic and pale [Hb=9.5] when presented to the anesthesia clinic of Labbafi Nejad Hospital for bilateral lensectomy. Induction and maintenance of anesthesia were carried out via the inhalation anesthesia method [N[2]O/O[2] and sevoflurane]. Laryngeal mask airway [LMA] was placed when achieving the appropriate depth of anesthesia. Bilateral lensectomy took 2 hours. After completion of the operation, the patient regained consciousness. His vital signs were stable and he was transferred to the recovery room and then to the ward. He was discharged from the hospital the day after the operation with no complications

Miocardiopatía hipertrófica neonatal: una forma de presentación clínica de la enfermedad de Pompe / Neonatal hypertrophic cardiomyopathy: a clinical presentation form of Pompe´s disease

La enfermedad de Pompe es una miopatía metabólica pordéficit de la enzima alfa-glucosidasa ácida lisosómica. Los pacientes afectados presentan hipotonía, alteración de la succión, falta de progreso, imposibilidad de adquirir pautas madurativas y miocardiopatía hipertrófica con insuficiencia cardíaca y muerte en el primer año. La manifestación más prominente es la cardíaca, el diagnóstico puede realizarse precozmente por la hipertrofia miocárdica. El diagnóstico tempranocobra mayor importancia a partir del desarrollo de una enzima recombinante humana (rhAGLU). Los pacientes tratados han demostrado mayor supervivencia y adquisición de pautas madurativas.Presentamos el caso de un recién nacido con miocardiopatíahipertrófica en quien se diagnosticó enfermedad de Pompe. A partir del paciente, se diagnosticó a su padre con la forma del adulto de la enfermedad, situación pocas veces descripta. Con el desarrollo de rhAGLU comenzó una nueva era en la historia de la enfermedad y nuestro paciente ya se encuentra en tratamiento

Prenatal exclusion of Pompe disease by electron microscopy.

Pompe disease is a lysosomal storage disorder caused by alpha-glucosidase deficiency. The disease is characterized by accumulation of glycogen in the lysosomes. The accumulation has unique ultrastructural features which enable a prenatal diagnosis by electron microscopy. We describe prenatal electron microscopic testing in a fetus of a mother whose previous child died of Pompe disease. The disease in the affected child was diagnosed by a decrease in alpha-glucosidase activity of his skin fibroblasts. Electron microscopy of the chorionic villus sample and amniocytes revealed normal findings, thus predicting an unaffected fetus. The study was confirmed by the birth of a normal neonate who was still healthy at the age of 12 months. Electron microscopy is useful in the first and second trimesters to exclude Pompe disease prenatally. This test can be use prenatally and provides families with reassurance.

Glicogenose tipo II / Glycogenosis type II

Objetivo: A Glicogenose tipo II ou Doença de Pompe é uma doença de armazenamento do glicogênio causada por deficiência enzimática. Pode manifestar-se em lactantes com hipotonia, cardiomegalia e hepatomegalia. As enzimas musculares estão elevadas, o ECG mostra intervalo PR curto, a radiografia de tórax apresenta cardiomegalia importante e a ecocardiografia mostra hipertrofia miocárdica. Firma-se diagnóstico através de análise histopatológica em biópsia de músculo estriado. Material e método: Os autores descrevem um caso de Glicogenose tipo II(Doença de Pompe) que cursou com insuficiência respiratória secundária a insuficiência cardíaca severa e discutem o diagnóstico, a terapêutica e a orientação a família utilizadas nesta doença potencialmente fatal. Conclusões: A Glicogenose tipo II, apesar de rara, dever ser considerada no diagnóstico diferencial nos quadros de insuficiência cardíaca relacionados a miocardiopatia, nos primeiros meses de vida

Clinical, pathological, and electron microscopic findings in two Thai children with Pompe disease.

The authors report on a Thai boy who first presented at age 7 months and an unrelated Thai girl in her neonatal period with hypotonia, cardiomegaly and hepatomegaly. Their chest roentgenograms showed markedly enlarged hearts, EKGs showed abnormally shortened PR intervals with gigantic QRS complexes, and electron microscopic studies of their skin samples showed glycogen accumulations surrounded by membranes. The boy died at age 22 months and the girl at age 9 months due mainly to cardiorespiratory failure. Autopsy of the girl showed marked accumulation of glycogen in the liver, heart and numerous additional tissues including her brain. The clinical, pathological, and electron microscopic findings of these two children are consistent with the diagnosis of Pompe disease. Pompe disease is an autosomal recessive disorder of glycogen metabolism resulting from deficiencies in activity of the lysosomal acid alpha-glucosidase. Definite diagnosis of the disease can be made from a biochemical test or a mutation analysis. To the authors' knowledge, no service laboratories in Thailand offer the tests. Because Thai children have occasionally been reported to be affected by Pompe disease, an attempt to establish a definite diagnostic test for Pompe disease in Thailand should be encouraged. With a definite diagnosis, the proper genetic counseling and prenatal diagnosis could be offered to the families.

Doença de Pompe ou glicogenose tipo IIa / Pompe's disease or type IIa glycogenosis

This is the report of a five-month-old child presenting clinical evidence of Pompe's disease: severe hypotonicity, hyporeflexia and congestive heart failure. The ECG showed a short PR interval, the chest radiography disclosed marked cardiomegaly, and the echocardiogram revealed marked left ventricular hypertrophy - the most typical finding of this disease. A skeletal muscle biopsy led to final diagnosis, because in the histopathologic study marked increased glycogen accumulation was evident. Death occurred two months after symptom onset.

Miopatía por déficit de maltasa ácida en el adulto / Myopathy due to acid maltase deficiency in an adult patient

We report a 46 years old male presenting with tetraparesis and severe respiratory involvement. He had moderately elevated serum creatine phosphokinase values and the electromyography showed myopathic alterations and irritative signs. In the muscle biopsy a vacuolar myopathy with increased collagen deposits was found. Circulating lymphocytes presented abnormal PAS positive granules in their cytoplasm

Diagnóstico clínico-bioquímico de la enfermedad de Pompe

La enfermedad de Pompe es una de las glicogenosis o enferemdad de depósito del glucógeno, que se transmite con carácter autosómico recesivo y es producida por la deficiencia de la enzima maltasa ácida que degrada glicógeno en los lisosomas. Se dintinguen tres tipos de enferemdad de Pompe : el tipo infantil que se acracteriza por la acumulación de glicógeno en el hígado, músculo esquelético y cardíaco y células del sistema nervioso central; los pacientes fallecen usaulamente antes de los dos años por falla cardiorespiratoria; el fenotipo juvenil se presenta en niños o jóvenes, no siempre involucra el sistema nervioso central o el músculo cardíaco y los pacientes fallecen generalmente durante la segunda década de vida; el tipo adulto cursa con distrofia muscular, algunas veces asociada con deficiencia respiratoria por compromiso de los músculos diagragma e intercostales. El pronóstico depende del grado de la falla respiratoria, la cual es causa principal de la muerte de estos pacientes. En este trabajo se informa el caso de un niño de seis meses de edad, afectado por cardiomegalia, retardo psicomotor e hipotonía. La confirmación bioquímica de la enfermedad se hizo determinando la actividad de la alfa-glucosidasa en leucocitos por dos métodos diferentes, usando como sustrato maltasa o el sustrato fluorescente 4-metil-umbeliferil-glucósido. La actividad de la maltasa ácida en leucocitos, usando maltosa como sustrato fue de 6,36Umol glucosa/min/g, con un valor de referencia entre 16-63 Umoles/glucosa/min/g de proteína. Con el sustrato fluorogénico, la activida en el paciente fue de 34.48 nanomoles/h/mg, de proteína, para un valor de referencia entre 194 y 258. La actividad en leucocitos tanto del padre como de la madre corresponde a un 60 por ciento del valor normal, hallado en personas en cuya familia no se sospecha dicha enfermedad.

Glucogenosis tipo II variedad infantil: infome de un caso y revisión de la literatura / Glucogenosis type II type infantile: report of a case and review of the literature

Se presenta un caso de Glucogenosis tipo II variedad infantil (enfermedad de Pompe) y se revisa la literatura con objeto de establecer las bases para la sospecha diagnóstica. Estudiamos un lactante femenino de 8 meses de edad con debilidad muscular e insuficiencia cardíaca. La radiografía de tórax, con cardiomegalia global. El electrocardiograma, con PR de 0.06 segundos, complejos QRS gigantes e hipertrofia biventricular. El ecocardiograma y la Cineangiografía mostrando hipocinesia e hipertrofia del ventrículo izquierdo. El paciente murió por insuficiencia cardíaca refractaria a su manejo. Los exámenes histoquímicos demostraron un acúmulo intracelular de glucógeno y ausencia de alfa 1,4 glucosidasa en músculo, riñón e hígado. Se estableció el diagnóstico de Glucogenosis tipo II variedad infantil. Concluimos que este padecimiento debe sospecharse en todo lactante con hipotonía muscular, insuficiencia cardíaca, cardiomegalia, electrocardiograma con PR corto, complejos QRS gigantes e hipertrofia biventricular y debe confirmase con biopsia muscular. En la literatura nacional revisada por los autores no se ha informado de ningún caso de enfermedad de Pompe