title: Sometimes when you hear hoof beats, it could be a zebra: consider the diagnosis of Fabry disease.
abstract: BACKGROUND
  Fabry disease is an X-linked lysosomal storage disorder that results from a deficiency of the enzyme α-galactosidase A. Fabry disease is present in 4-5% of men with unexplained left ventricular hypertrophy or cryptogenic stroke. As enzyme replacement therapy is now more widely available, it is important to recognise the signs and symptoms of the disease and establish the diagnosis so that early treatment can be started before irreversible organ damage occurs.
  
  
  METHODS
  A previously fit and well 32-year-old Caucasian male presented with multisystem dysfunction including renal impairment. Although he had no suggestive symptoms, a diagnosis of Fabry disease was first established on a native renal biopsy. This was confirmed by enzymatic testing and subsequent genetic analysis that revealed a potentially new pathogenic variant.
  
  
  CONCLUSIONS
  This case highlights the importance both of Fabry disease as a differential diagnosis in patients with renal impairment in the context of multi-system disease and also of adequate tissue sampling for electron microscopy when performing native renal biopsies.
authors: Department of Infection, Immunity & Inflammation, School of Medicine and Biological Sciences, University of Leicester, Leicester, UK. jb343@le.ac.uk
authors: James O
authors: JO
authors: Burton
authors: John P
authors: JP
authors: Dormer
authors: Helen E
authors: HE
authors: Binns
authors: Warren P
authors: WP
authors: Pickering
mesh_terms: D000328:Adult; D000818:Animals; D003937:Diagnosis, Differential; D018397:Equidae; D000795:Fabry Disease / Q000175:diagnosis* / Q000235:genetics*; D006724:Hoof and Claw; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis / Q000235:genetics; D008297:Male