Case of multiple sulfatase deficiency and ocular albinism: a diagnostic odyssey.
BACKGROUND
Multiple sulfatase deficiency (MSD) is a rare autosomal recessive inborn error of lysosomal metabolism. The clinical phenotypic spectrum encompasses overlapping features of variable severity and is suggestive of individual single sulfatase deficiencies (i.e., metachromatic leukodystrophy, mucopolysaccharidosis, and X-linked ichthyosis).


METHODS
We describe a 3-year-old male with severe hypotonia, developmental regression and progressive neurodegeneration, coarse facial features, nystagmus (from ocular albinism), and dysmyelinating motor sensory neuropathy. Ethics approval was obtained from the Western University Ontario.


RESULTS
Extensive investigative work-up identified deficiencies of multiple sulfatases: heparan sulfate sulfamidase: 6.5 nmoles/mg/protein/17 hour (reference 25.0-75.0), iduronate-2-sulfate sulfatase: 9 nmol/mg/protein/4 hour (reference 31-110), and arylsulfatase A: 3.8 nmoles/hr/mg protein (reference 22-50). The identification of compound heterozygous pathogenic mutations in the SUMF1 gene c.836 C>T (p.A279V) and c.1045C>T (p.R349W) confirmed the diagnosis of MSD.


CONCLUSIONS
The complex clinical manifestations of MSD and the unrelated coexistence of ocular albinism as in our case can delay diagnosis. Genetic counselling should be provided to all affected families.
Departments of Paediatrics,Western University,London,Ontario,Canada.
Chitra
C
Prasad
Departments of Paediatrics,Western University,London,Ontario,Canada.
C Anthony
CA
Rupar
Departments of Paediatrics,Western University,London,Ontario,Canada.
Craig
C
Campbell
Departments of Paediatrics,Western University,London,Ontario,Canada.
Melanie
M
Napier
Departments of Paediatrics,Western University,London,Ontario,Canada.
David
D
Ramsay
Medical Imaging,Western University,London,Ontario,Canada.
K Y
KY
Tay
Departments of Paediatrics,Western University,London,Ontario,Canada.
Sapna
S
Sharan
Departments of Paediatrics,Western University,London,Ontario,Canada.
Asuri N
AN
Prasad
D016117:Albinism, Ocular / Q000150:complications* / Q000175:diagnosis* / Q000235:genetics; D002675:Child, Preschool; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D052517:Multiple Sulfatase Deficiency Disease / Q000150:complications* / Q000175:diagnosis* / Q000235:genetics