Acute metabolic decompensation and sudden death in Barth syndrome: report of a family and a literature review.
Barth syndrome presents in infancy with hypotonia, dilated cardiomyopathy, and neutropenia. We report a patient whose family history included two males who had died suddenly at the age of 15 days and 2 years, respectively. The index case presented with acute metabolic decompensation at 13 days of age. Within 8 h of presenting with metabolic acidosis (pH 7.13), lactic acidemia (18.5 mmol/l), hyperammonemia (375 microg/dl), hypoglycemia (25 mg/dl), and coagulopathy, the patient developed respiratory failure and required intubation. The diagnosis was established by the presence of left ventricular noncompaction and molecular analysis (c.C153G or Y51X mutation of the TAZ gene). The gene product, taffazin, is a homologue of the glycerolipid transferases involved in the phospholipid metabolism as tetralinoleoyl-cardiolipin, a component of the mitochondrial inner membrane. In conclusion, mutations in taffazin impair mitochondrial respiratory chain complexes, which may results in the acute metabolic decompensation and sudden death; cardiac transplantation is the only possibility at the present time.
Yen
Ting-Yu
TY
Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Hwu
Wuh-Liang
WL
Chien
Yin-Hsiu
YH
Wu
Mei-Hwan
MH
Lin
Ming-Tai
MT
Tsao
Lon-Yen
LY
Hsieh
Wu-Shiun
WS
Lee
Ni-Chung
NC
D000140:Acidosis, Lactic / Q000209:etiology; D000217:Acyltransferases; D002311:Cardiomyopathy, Dilated / Q000235:genetics*; D003645:Death, Sudden; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D022124:Hyperammonemia / Q000209:etiology; D007003:Hypoglycemia / Q000209:etiology; D007223:Infant; D008297:Male; D008661:Metabolism, Inborn Errors / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology / Q000503:physiopathology; D028361:Mitochondrial Diseases / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology; D013577:Syndrome; D014157:Transcription Factors / Q000235:genetics*
D014157:Transcription Factors; D000217:Acyltransferases; C108675:TAFAZZIN protein, human