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Asymptomatic pediatric presentation of S‐adenosylhomocysteine hydrolase deficiency

Authors: Patrícia Lipari Pinto; Marjorie Dixon; Sniya Sudhakar; Ivo Baric; Julien Baruteau;

Asymptomatic pediatric presentation of S‐adenosylhomocysteine hydrolase deficiency

Abstract

AbstractS‐adenosylhomocysteine hydrolase deficiency is an autosomal recessive inborn error of metabolism affecting methylation by disrupting the methionine cycle. Its clinical spectrum spans from severe perinatal encephalomyopathy and liver failure to asymptomatic course in patients with isolated hypermethioninemia. We present two new cases of S‐adenosylhomocysteine hydrolase deficiency from Pakistani origin clinically asymptomatic at presentation. Both siblings showed mild chronic liver failure and elevation of creatine kinase. The older patient presented at 6 years of age with isolated verbal processing difficulty and mild diffuse leukodystrophy, reversible 12 months after introduction of methionine dietary restriction. The patient showed subtle atrophy in the muscle MRI at the age of 7 years. S‐adenosylhomocysteine hydrolase deficiency was confirmed with homozygous missense variant c.146G>A (p.Arg49His) in the AHCY gene, a genotype previously reported in Pakistani patients with mild presentation. Dietary methionine restriction decreased plasma methionine but not plasma S‐adenosylhomocysteine and S‐adenosylmethionine. This work expands the mild spectrum of S‐adenosylhomocysteine hydrolase deficiency with no noticeable clinical symptoms in children, highlighting a specific hotspot variant from South Asia. This mild form of the disease is likely underdiagnosed and raises the question of therapeutic management to prevent long‐term complications documented in the literature, such as hepatocellular carcinoma and myopathy in early adulthood.

Keywords

AHCY gene, S‐adenosylhomocysteine hydrolase deficiency, S‐adenosylhomocysteine, Genetics, Case Report, hepatocellular carcinoma, QH426-470, RC648-665, S‐adenosylmethionine, Diseases of the endocrine glands. Clinical endocrinology, hypermethioninemia

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
Average
Average
Average
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gold