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What lies beneath: Fabry nephropathy in a female patient with severe cerebrovascular disease.
MedLine Citation:
PMID:  23537685     Owner:  NLM     Status:  In-Data-Review    
Fabry disease is an X-linked inborn error of metabolism, which is caused by the deficiency of α-galactosidase A, leading to progressive accumulation of neutral glycosphingolipids and a-galactosyl breakdown products in most body fluids and several tissues, resulting in the clinical manifestations. The onset of Fabry disease symptoms in females is not observed as early as in males. We report a novel presentation of Fabry disease in a female patient with medical history of relapsing strokes and brain magnetic resonance angiography showing signs of microangiopathy and multiple lacunar strokes that were first diagnosed as Moyamoya disease (a chronic progressive cerebrovascular disease). The patient subsequently displayed increased levels of serum creatinine and proteinuria. Diagnosis of Fabry disease was made by a renal biopsy and was confirmed by molecular studies showing a missense mutation: c1066C > T (het) [R356W]. The diagnosis was delayed by 21 years with respect to her first symptom (stroke), probably because her initial clinical presentation was neurological and diagnosed as Moyamoya disease. Other factors that contributed to the delay of the diagnosis were the lack of acute or chronic pain (neuropathic pain) and angiokeratomas. Some similarities in the pathogenic aspects of the patient's vascular lesions lead us to speculate that this patient has Fabry disease, with a phenotype that had not yet been described. It is necessary to be aware of this possibility to avoid misdiagnosis of Fabry disease as Moyamoya disease.
Elen A Romão; Charles M Lourenço; Wilson Marques Júnior; Arndt Rolfs; Veronica Muñoz; Osvaldo M Vieira Neto; Marcio Dantas; Gyl E B Silva; Roberto S Costa
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical nephrology     Volume:  79     ISSN:  0301-0430     ISO Abbreviation:  Clin. Nephrol.     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0364441     Medline TA:  Clin Nephrol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  330-4     Citation Subset:  IM    
Nephrology Division, Neurogenetics Division, Department of Neurology, Clinics Hospital of Ribeirao Preto, Faculty of Medicine of Ribeirao Preto, University of São Paulo, Brazil and Department of Neurology, Rostock University, Germany and Department of Pathology, Faculty of Medicine of Ribeirao Preto, University of São Paulo, Brazil.
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