Spinal form cerebrotendinous xanthomatosis patient with long spinal cord lesion.
Cerebrotendinous xanthomatosis (CTX) is an autosomal recessively inherited lipid storage disease caused by mutation in the CYP27A1 gene. Spinal form CTX is a rare clinical subgroup of CTX and only 14 patients from 11 families have been reported to date. Here, we report the first Asian patient with spinal form CTX showing characteristic radiological findings.



The patient, a 46-year-old Japanese male, developed sensory disturbance of the lower legs at 39 and spastic gait at 46 years of age. Spinal cord magnetic resonance imaging (MRI) revealed a long hyperintense lesion involving lateral corticospinal tracts and gracile tracts in the cervical and thoracic cord on T2-weighted images. Gallium-67 (67Ga) scintigraphy revealed abnormal uptake in the Achilles tendons and the serum cholestanol level was elevated. CYP27A1 gene analysis identified homozygous missense mutation, c.1214G>A (p.R405Q). The patient was treated with atorvastatin monotherapy, which reduced serum cholestanol to less than 50% of the pretreatment level.



Spinal form CTX should be considered in the differential diagnosis of cryptogenic myelopathy, especially in patients with a long spinal cord lesion, as treatment with chenodeoxycholic acid and/or competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase reverse the metabolic derangement and prevent the neurologiccal dysfunction.
a Department of Medicine (Neurology and Rheumatology) , Shinshu University School of Medicine , Matsumoto , Japan.
Ryuta
R
Abe
a Department of Medicine (Neurology and Rheumatology) , Shinshu University School of Medicine , Matsumoto , Japan.|b Institute for Biomedical Sciences , Shinshu University , Matsumoto , Japan.
Yoshiki
Y
Sekijima
a Department of Medicine (Neurology and Rheumatology) , Shinshu University School of Medicine , Matsumoto , Japan.
Tomomi
T
Kinoshita
a Department of Medicine (Neurology and Rheumatology) , Shinshu University School of Medicine , Matsumoto , Japan.
Tsuneaki
T
Yoshinaga
c Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology , Yamagata University Faculty of Medicine , Japan.
Shingo
S
Koyama
c Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology , Yamagata University Faculty of Medicine , Japan.
Takeo
T
Kato
a Department of Medicine (Neurology and Rheumatology) , Shinshu University School of Medicine , Matsumoto , Japan.|b Institute for Biomedical Sciences , Shinshu University , Matsumoto , Japan.
Shu-Ichi
SI
Ikeda
D053493:Cholestanetriol 26-Monooxygenase / Q000235:genetics; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D020125:Mutation, Missense; D011712:Pyramidal Tracts / Q000000981:diagnostic imaging* / Q000473:pathology; D013118:Spinal Cord Diseases / Q000175:diagnosis*; D019294:Xanthomatosis, Cerebrotendinous / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics
C506831:CYP27A1 protein, human; D053493:Cholestanetriol 26-Monooxygenase
CYP27A1gene; Cerebrotendinous xanthomatosis; Cholestanol; Long spinal cord lesion; Myelopathy