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Background  Cholesterol ester storage disease (CESD) is an autosomal recessive illness that results from mutations in the  LIPA  gene encoding lysosomal acid lipase. CESD patients present in childhood with hepatomegaly and dyslipidemia characterized by elevated total and low-density lipoprotein cholesterol (LDL-C), with elevated triglycerides and depressed high-density lipoprotein cholesterol (HDL-C). Usual treatment includes a low fat diet and a statin drug.    Results  In an 18-year old with CESD, we documented compound heterozygosity for two  LIPA  mutations: a novel frameshift nonsense mutation and a deletion of exon 8. The patient had been treated with escalating doses of lovastatin for ~80 months, with ~15% decline in mean LDL-C. The addition of ezetimibe 10 mg to lovastatin 40 mg resulted in an additional ~16% decline in mean LDL-C.    Conclusion  These preliminary anecdotal findings in a CESD patient with novel  LIPA  mutations support the longer term safety of statins in an adolescent patient and provide new data about the potential efficacy and tolerability of ezetimibe in this patient group.

Treatment of dyslipidemia with lovastatin and ezetimibe in an adolescent with cholesterol ester storage disease