Publication Type : Case Reports
Publisher : Ovid Technologies (Wolters Kluwer Health)
Source : Neurology
Url : https://doi.org/10.1212/wnl.0000000000009479
Campus : Faridabad
School : School of Medicine
Year : 2020
Abstract : A 10-month-old girl presented with global developmental delay, epileptic spasms, and easy bruisability. She was fourth-born of third-degree consanguineous parents with 3 healthy siblings. The perinatal period was uneventful. Examination revealed microcephaly, central hypotonia, acrocyanosis, mottled skin, and petechiae over extremities (figure 1). Neuroimaging revealed peculiar findings (figure 2). EEG revealed modified hypsarrhythmia (figure 3). Epileptic spasms resolved with oral prednisolone therapy (given at 3 mg/kg/d for 2 weeks followed by tapering over 6 weeks). She had elevated C4-acylcarnitines on tandem mass spectrometry (TMS) and urinary ethylmalonic acid on urine gas chromatography mass spectrometry (GCMS). The diagnosis of ethylmalonic encephalopathy (EE) was confirmed genetically (c.487C > T; p.Arg163Trp homozygous variation in ETHE1). She was initiated on N-acetyl cysteine, metronidazole, and mitochondrial cocktail but died of an acute crisis at 14 months of age.
Cite this Research Publication : Priyanka Madaan, Lokesh Saini, Sameer Vyas, Savita Verma Attri, Jitendra Kumar Sahu, Mystery Case: An infant with developmental delay, epileptic spasms, and acrocyanosis, Neurology, Ovid Technologies (Wolters Kluwer Health), 2020, https://doi.org/10.1212/wnl.0000000000009479