title: Unusual presentation of congenital disorder of glycosylation type 1a: congenital persistent thrombocytopenia, hypertrophic cardiomyopathy and hydrops-like aspect due to marked peripheral oedema.
abstract: Of the congenital disorder of glycosylation (CDG) syndromes, type 1a is the most common. CDG 1a is a multisystem disorder with a wide clinical spectrum. We report on a term newborn with a severe and fatal clinical course of CDG 1a syndrome. Skin fibroblasts showed a reduced activity of phosphomannomutase 2 (PMM2) and mutation analysis revealed a compound heterozygous PMM2gene mutation (F119L/F157S). Presenting features at birth were hypertrophic non-obstructive cardiomyopathy, "orange-peel" skin, inverted nipples and a hydrops-like aspect due to marked peripheral oedema. Suspected hydrops fetalis was not confirmed due to lack of ascites and pleural effusions. Striking clinical problems were therapy-resistant arterial hypertension, recurrent pericardial and pleural effusions and feeding difficulties with failure to thrive. Persistent congenital thrombocytopenia and hyperferritinaemia in the absence of infection were noted. Bone marrow cytology revealed a macrophage activation of unknown aetiology.
  
  
  CONCLUSIONS
  Congenital thrombocytopenia, unspecific macrophage activation and a hydrops-like aspect without a real hydrops fetalis broaden the already wide phenotypic spectrum of congenital disorder of glycosylation syndrome type 1a.
authors.affiliation: University Children's Hospital, Oststrasse 21-25, 04317 Leipzig, Germany. vera.noelle@medizin.uni-leipzig.de
authors.forename: Vera
authors.initials: V
authors.lastname: Noelle
authors.forename: Matthias
authors.initials: M
authors.lastname: Knuepfer
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Pulzer
authors.forename: Volker
authors.initials: V
authors.lastname: Schuster
authors.forename: Werner
authors.initials: W
authors.lastname: Siekmeyer
authors.forename: Gert
authors.initials: G
authors.lastname: Matthijs
authors.forename: Christoph
authors.initials: C
authors.lastname: Vogtmann
mesh_terms: D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000151:congenital / Q000188:drug therapy; D004487:Edema / Q000150:complications* / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D006031:Glycosylation; D006801:Humans; D007231:Infant, Newborn; D017875:Phosphotransferases (Phosphomutases) / Q000235:genetics* / Q000378:metabolism; D013921:Thrombocytopenia / Q000150:complications* / Q000151:congenital
chemical_list: D017875:Phosphotransferases (Phosphomutases); C052799:phosphomannomutase