title: Late-Onset visceral presentation with cardiomyopathy and without neurological symptoms of adult Sanfilippo A syndrome.
abstract: Sanfilippo A syndrome, mucopolysaccharidosis type IIIA, is caused by a deficiency of heparan sulphamidase activity, and usually presents in childhood with neurodegeneration leading to death in teenage years. Visceral symptoms are limited to coarsening and diarrhea. We now describe an adult patient who presented with cardiomyopathy. At age 45 years she had hypertension, and the next year she developed a progressively worsening cardiomyopathy with prominent apical hypertrophy and atrial fibrillation. At age 53, she had severe concentric hypertrophic nonobstructive cardiomyopathy in both ventricles. There was no coarsening of features. Neurologic function, skeleton, cornea, liver, and spleen were normal. Percutaneous endomyocardial biopsy showed ballooned cardiomyocytes with storage vacuoles, containing acid mucopolysaccharides. Leucocytes, uterus, and brain biopsy did not show this storage material. There was a slight increase in total urine mucopolysaccharides, with an increased proportion of heparan sulfates. Heparan sulphamidase activity was deficient in leukocytes and heparan sulphamidase protein and activity were reduced in cultured fibroblasts. No mutations were identified after sequencing of the heparan sulphamidase gene at the cDNA and the genomic level. This new clinical presentation expands the clinical spectrum of Sanfilippo A syndrome to include a primary visceral presentation of cardiomyopathy without neurologic symptoms in the adult. The late onset may be related to the residual heparan sulphamidase activity. The genetic basis of this new variant is still unclear. Physicians evaluating adults must remain aware of possible new adult presentations of storage conditions.
authors.affiliation: Department of Pediatrics, University Hospital Gasthuisberg, Leuven, Belgium. Johan.Vanhove@uz.kuleuven.ac.be
authors.forename: Johan L K
authors.initials: JL
authors.lastname: Van Hove
authors.forename: Ron A
authors.initials: RA
authors.lastname: Wevers
authors.forename: Johan
authors.initials: J
authors.lastname: Van Cleemput
authors.forename: Philippe
authors.initials: P
authors.lastname: Moerman
authors.forename: Raf
authors.initials: R
authors.lastname: Sciot
authors.forename: Gert
authors.initials: G
authors.lastname: Matthijs
authors.forename: Els
authors.initials: E
authors.lastname: Schollen
authors.forename: Jan G N
authors.initials: JG
authors.lastname: de Jong
authors.forename: William F
authors.initials: WF
authors.lastname: Carey
authors.forename: Viv
authors.initials: V
authors.lastname: Muller
authors.forename: Cath
authors.initials: C
authors.lastname: Nicholls
authors.forename: Kelly
authors.initials: K
authors.lastname: Perkins
authors.forename: John J
authors.initials: JJ
authors.lastname: Hopwood
mesh_terms: D009202:Cardiomyopathies / Q000150:complications / Q000235:genetics / Q000473:pathology*; D005260:Female; D005347:Fibroblasts / Q000201:enzymology; D006025:Glycosaminoglycans / Q000652:urine; D006497:Heparan Sulfate / Q000652:urine; D006801:Humans; D006867:Hydrolases / Q000172:deficiency; D008875:Middle Aged; D009084:Mucopolysaccharidosis III / Q000150:complications / Q000235:genetics / Q000473:pathology*
chemical_list: D006025:Glycosaminoglycans; D006497:Heparan Sulfate; D006867:Hydrolases; C022708:N-sulfoglucosamine sulfohydrolase