Document Detail

Three new cases of late-onset cblC defect and review of the literature illustrating when to consider inborn errors of metabolism beyond infancy.
MedLine Citation:
PMID:  25398587     Owner:  NLM     Status:  Publisher    
BackgroundThe cblC defect is a rare inborn error of intracellular cobalamin metabolism. Biochemical hallmarks are elevated homocysteine and low methionine in plasma accompanied by methylmalonic aciduria. Due to the heterogeneous clinical picture, patients with the late-onset form of the disease (onset >12 months) come to the attention of diverse medical specialists, e.g. paediatricians, neurologists, nephrologists, psychiatrists or haematologists. The report reviews the published clinical data and adds three new cases to raise awareness for this severe but often treatable disease.MethodsThe Pubmed and the Cochrane databases were searched for clinical reports on cblC patients and three unreported cases are presented to illustrate the clinical spectrum.ResultsReports on 58 cases (30 females, 22 males, 6¿=¿no information) and the three new cases underlined the clinical heterogeneity of the disease. Time between first symptoms and diagnosis ranged from three months to more than 20 years. Haemolytic uraemic syndrome and pulmonary hypertension were main presenting symptoms in preschool children. In older children / adolescents, psychiatric symptoms, cognitive impairment, ataxia and myelopathy were frequently observed while thromboembolic events and glomerulopathies were almost exclusively seen in adults. Brain atrophy, white matter lesions and myelopathy were frequently encountered. The majority of patients showed marked biochemical and clinical response to treatment with parenteral hydroxocobalamin combined with oral betaine, folate, carnitine and rarely methionine. The course was less favourable in late treated or untreated patients.ConclusionsThe late-onset cblC defect is a rare disease and unfortunately, diagnosis is often delayed. Raising awareness for this disorder can significantly improve patients¿ outcome and perspective by timely initiation of targeted treatment. Newborn screening (NBS) for the cblC defect might be of benefit especially for late-onset patients since treatment seems efficient when initiated before irreversible organ damage. In general, inborn errors of metabolisms should be considered in unexplained medical cases at any age, especially in patients with multisystemic disease. More specifically, total homocysteine in plasma and methylmalonic acid in urine / plasma should be measured in unexplained neurologic, psychiatric, renal, haematologic and thromboembolic disease.
Martina Huemer; Sabine Scholl-Bürgi; Karine Hadaya; Ilse Kern; Ronny Beer; Klaus Seppi; Brian Fowler; Matthias R Baumgartner; Daniela Karall
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-15
Journal Detail:
Title:  Orphanet journal of rare diseases     Volume:  9     ISSN:  1750-1172     ISO Abbreviation:  Orphanet J Rare Dis     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-11-15     Completed Date:  -     Revised Date:  2014-11-16    
Medline Journal Info:
Nlm Unique ID:  101266602     Medline TA:  Orphanet J Rare Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  161     Citation Subset:  -    
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