title: Diversity of clinical symptoms in A3243G mitochondrial DNA mutation (MELAS syndrome mutation).
abstract: BACKGROUND
  MELAS (mitochondrial myopathy, lactic acidosis and stroke-like episodes) is one of the most common mitochondrial encephalomyopathies.
  
  
  METHODS
  We present four children with A3243G MELAS mtDNA mutation and give a summary of clinical MELAS symptoms reported in the literature. Serum lactate elevation, mosaic pattern of COX deficit and decreased activity of complex I and IV in the muscle biopsy were found in all cases. RRFs were recognized in three out of four.
  
  
  RESULTS
  The main features seen in all our patients were poor growth and fatigability with muscle weakness. All presented epileptic jerks of various character, some deformation features (recurrent pretibial and peritarsal edema, large swollen-looking hands and feet, hypertelorism and protruding ears) and some cutaneous lesions (atopic dermatitis, local melanoderma, asymmetric vascular dilatation). Stroke-like episodes, multihormonal hypopituitarism, sensorineural hypoacusis, pigmentary retinal degeneration, intracranial calcification, heart involvement, recurrent vomiting or abdominal pain were seen only in individual cases. The homonymous hemianopia frequently reported in the literature was not a feature of our patients. One of them suffered from nonspecific sialoadenitis never mentioned in the literature.
  
  
  CONCLUSIONS
  Morphological, enzymatic and molecular investigations of a muscle biopsy sample should be undertaken to improve early MELAS detection in patients with any multiorgan disease associated with serum lactate elevation.
authors.affiliation: Department of Pathology, Children's Memorial Health Institute, Warsaw, Poland. pronicka@czd.waw.pl
authors.forename: Maciej
authors.initials: M
authors.lastname: Pronicki
authors.forename: Jolanta
authors.initials: J
authors.lastname: Sykut-Cegielska
authors.forename: Hanna
authors.initials: H
authors.lastname: Mierzewska
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Tońska
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Karczmarewicz
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Iwanicka
authors.forename: Ewa
authors.initials: E
authors.lastname: Bartnik
authors.forename: Ewa
authors.initials: E
authors.lastname: Pronicka
mesh_terms: D017668:Age of Onset; D001706:Biopsy; D002675:Child, Preschool; D004252:DNA Mutational Analysis; D004272:DNA, Mitochondrial; D005260:Female; D006801:Humans; D007773:Lactates / Q000097:blood; D017241:MELAS Syndrome / Q000175:diagnosis* / Q000235:genetics*; D008297:Male; D009132:Muscles / Q000473:pathology; D017354:Point Mutation; D011451:Prostaglandin-Endoperoxide Synthases / Q000378:metabolism
chemical_list: D004272:DNA, Mitochondrial; D007773:Lactates; D011451:Prostaglandin-Endoperoxide Synthases