title: Hepatic Fibrinogen Storage Disease in a Patient with Hypofibrinogenemia: Report of a Case with a Missense Mutation of the FGA Gene.
abstract: We report a 9-year-old patient with abnormal liver tests found incidentally during routine bloodwork as part of a preoperative evaluation for excision of a benign cyst. A liver biopsy demonstrated hepatocytes to have pale and expanded cytoplasm that contained multiple vague globular eosinophilic inclusions. Electron microscopy showed fingerprint-like structures in the dilated cisternae of the rough endoplasmic reticulum, characteristic of fibrinogen. Whole exome sequencing identified a heterozygous missense mutation at codon 35 of the fibrinogen α (FGA) gene. No mutation was identified in the β or γ chains. His plasma fibrinogen levels were found to be decreased to 85 mg/dL (normal range 215-464). His family history was pertinent for his mother and maternal grandfather with hypofibrinogenemia. He had not had any significant bleeding episodes except for minor bruising over the shins. This case illustrates a rare etiology of storage disease that causes abnormal liver function tests.
authors.affiliation: Department of Pathology and Laboratory Medicine, Baylor University Medical Center, Dallas, Texas.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lee
authors.affiliation: Department of Pediatric Gastroenterology, Ronald Reagan UCLA Medical Center, Los Angeles, California.
authors.forename: Robert
authors.initials: R
authors.lastname: Venick
authors.affiliation: Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California.
authors.forename: Sunita
authors.initials: S
authors.lastname: Bhuta
authors.affiliation: Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California.
authors.forename: Xinmin
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Pathology and Laboratory Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California.
authors.forename: Hanlin L
authors.initials: HL
authors.lastname: Wang
mesh_terms: D000347:Afibrinogenemia / Q000097:blood / Q000175:diagnosis* / Q000235:genetics; D002648:Child; D005340:Fibrinogen / Q000235:genetics; D022781:Hepatocytes / Q000473:pathology* / Q000648:ultrastructure; D006801:Humans; D019934:International Normalized Ratio; D008099:Liver / Q000473:pathology* / Q000648:ultrastructure; D008297:Male; D008854:Microscopy, Electron; D020125:Mutation, Missense; D010314:Partial Thromboplastin Time; D011517:Prothrombin Time
chemical_list: C464794:fibrinogen Aalpha; D005340:Fibrinogen