Open AccessRelapsing encephalopathy in a patient with -methylacyl-CoA racemase deficiency
Author(s) -
Sian Thompson,
J Calvin,
Sarah Hogg,
Sacha Ferdinandusse,
Ronald J. A. Wanders,
Roger A. Barker
Publication year - 2009
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr.08.2008.0814
Subject(s) - medicine , neurology , encephalopathy , intensive care medicine , pediatrics , psychiatry
α-Methylacyl-CoA racemase (AMACR) deficiency is a rare disorder of fatty acid metabolism which has recently been described in three adult cases. We have identified a further patient with clinical features of a relapsing encephalopathy, seizures and cognitive decline over a 40 year period. Biochemical studies revealed grossly elevated plasma pristanic acid levels, and a deficiency of AMACR in skin fibroblasts. Sequence analysis of AMACR cDNA identified a homozygous point mutation (c154T>C). This case adds to the phenotypic variation seen in this peroxisomal disorder and highlights the importance of screening for plasma pristanic acid levels in patients with unexplained relapsing encephalopathies.