title: Variable presentation of cytochrome c oxidase deficiency.
abstract: OBJECTIVE
  To describe three patients with cytochrome c oxidase deficiency.
  
  
  METHODS
  Patient series.
  
  
  METHODS
  Tertiary care children's hospital in Arkansas.
  
  
  METHODS
  A sibling pair and an unrelated patient referred for evaluation and found to have cytochrome c oxidase deficiency.
  
  
  METHODS
  None.
  
  
  RESULTS
  Affected individuals had the characteristic presentation of psychomotor regression, growth deficiency, and lactic acidosis. The severity of the clinical course was found to correlate with the lactate-pyruvate ratio. Two of the infants had evidence, on magnetic resonance imaging, of subacute necrotizing encephalomyelopathy (Leigh disease). The most severely affected child had an unusual presentation of prenatal onset of structural anomalies including glabellar prominence, abnormal hair, loose skin, inguinal hernias, and hypospadias.
  
  
  CONCLUSIONS
  The presentation and clinical course of cytochrome c oxidase deficiency are highly variable and the diagnosis of cytochrome c oxidase deficiency should be considered in all patients with lactic acidosis or subacute necrotizing encephalomyelopathy. Particular consideration should be given to this diagnosis when lactic acidosis is found in a neonate with structural anomalies.
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock.
authors.forename: K
authors.initials: K
authors.lastname: Keppler
authors.forename: C
authors.initials: C
authors.lastname: Cunniff
mesh_terms: D030401:Cytochrome-c Oxidase Deficiency; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007773:Lactates / Q000097:blood; D019344:Lactic Acid; D008297:Male; D008661:Metabolism, Inborn Errors / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D011773:Pyruvates / Q000097:blood; D019289:Pyruvic Acid
chemical_list: D007773:Lactates; D011773:Pyruvates; D019344:Lactic Acid; D019289:Pyruvic Acid