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Freitas HMP, Mançano AD, Rodrigues RS, Hochhegger B, Torres PPTES, Escuissato D, Araujo Neto CA, Marchiori E. Niemann-Pick disease type B: HRCT assessment of pulmonary involvement. ACTA ACUST UNITED AC 2019; 43:451-455. [PMID: 29340494 PMCID: PMC5792045 DOI: 10.1590/s1806-37562017000000062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/18/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To analyze HRCT findings in patients with Niemann-Pick disease (NPD) type B, in order to determine the frequency of HRCT patterns and their distribution in the lung parenchyma, as well as the most common clinical characteristics. METHODS We studied 13 patients (3 males and 10 females) aged 5 to 56 years. HRCT images were independently evaluated by two observers, and disagreements were resolved by consensus. The inclusion criteria were presence of abnormal HRCT findings and diagnosis of NPD type B confirmed by histopathological examination of a bone marrow, lung, or liver biopsy specimen. RESULTS The most common clinical findings were hepatosplenomegaly and mild to moderate dyspnea. The most common HRCT patterns were smooth interlobular septal thickening and ground-glass opacities, which were both present in all patients. Intralobular lines were present in 12 patients (92.3%). A crazy-paving pattern was observed in 5 patients (38.4%), and areas of air trapping were identified in only 1 case (7.6%). Pulmonary involvement was bilateral in all cases, with the most affected area being the lower lung zone. CONCLUSIONS Smooth interlobular septal thickening, with or without associated ground-glass opacities, in patients with hepatosplenomegaly is the most common finding in NPD type B.
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Affiliation(s)
| | - Alexandre Dias Mançano
- . Departamento de Radiologia, Radiologia Anchieta - Hospital Anchieta, Taguatinga (DF) Brasil
| | - Rosana Souza Rodrigues
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil.,. Departamento de Radiologia, Instituto D'Or de Pesquisa e Educação, Rio de Janeiro (RJ) Brasil
| | - Bruno Hochhegger
- . Departamento de Radiologia, Santa Casa de Porto Alegre, Porto Alegre (RS) Brasil
| | | | - Dante Escuissato
- . Departamento de Radiologia, Universidade Federal do Paraná, Curitiba (PR) Brasil
| | | | - Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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Lario A, de Miguel C, Ojeda E, Gil S, Coll MJ, Alfonso P. [New mutation in a young woman diagnosed with Niemann-Pick disease type C]. Med Clin (Barc) 2016; 146:494-6. [PMID: 27016452 DOI: 10.1016/j.medcli.2016.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 01/23/2016] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJETIVE To describe a new molecular variant of Niemann-Pick disease type C (NPC) in a 27 year-old patient with splenomegaly and abolition of osteotendinous reflexes. MATERIAL AND METHODS NPC1 is the main gene with described mutation in NPC disease. Here we report a case with a new mutation, p.N916S, not described before in a patient diagnosed with NPC. RESULTS p.N916S was described as a cause of NPC disease by predictive programmes Mutation Master, PolyPhen2 and SIFT. CONCLUSIONS p.N916S is a new mutation detected as a cause of NPC disease in a patient without severe neurological symptoms.
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Affiliation(s)
- Ana Lario
- Servicio de Hematología y Hemoterapia, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.
| | - Carlos de Miguel
- Servicio de Hematología y Hemoterapia, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Emilio Ojeda
- Servicio de Hematología y Hemoterapia, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Santiago Gil
- Servicio de Hematología y Hemoterapia, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - María J Coll
- Centro de Diagnóstico Biomédico, Hospital Clínic, Barcelona, España
| | - Pilar Alfonso
- Departamento de Bioquímica y Biología Celular y Molecular, Universidad de Zaragoza, Zaragoza, España
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Pulmonary Involvement in Niemann-Pick Disease: A State-of-the-Art Review. Lung 2016; 194:511-8. [PMID: 27164983 DOI: 10.1007/s00408-016-9893-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
Niemann-Pick disease is a rare autosomal recessive lysosomal storage disease with three subtypes. Types A and B result from a deficiency of acid sphingomyelinase activity, associated with the accumulation of lipid-laden macrophages (so-called Niemann-Pick cells) in various tissues, especially the liver and spleen. Type A is a fatal neurodegenerative disorder of infancy. Type B Niemann-Pick disease is a less severe form with milder neurological involvement, characterized by hepatosplenomegaly, hyperlipidemia, and pulmonary involvement; most patients live into adulthood. Type C Niemann-Pick disease is a complex lipid storage disorder caused by defects in cholesterol trafficking, resulting in a clinical presentation dominated by neurological involvement. Pulmonary involvement occurs in all three types of Niemann-Pick disease, but most frequently in type B. Respiratory manifestations range from a lack of symptoms to respiratory failure. Progression of respiratory disease is slow, but inexorable, due to the accumulation of Niemann-Pick cells in the alveolar septa, bronchial walls, and pleura, potentially leading to a progressively worsening restrictive pattern on pulmonary function testing. Bronchoalveolar lavage has important diagnostic value because it shows the presence of characteristic Niemann-Pick cells. Radiographic findings consist of a reticular or reticulonodular pattern and, eventually, honeycombing, involving mainly the lower lung zones. The most common changes identified by high-resolution computed tomography are ground-glass opacities, mild smooth interlobular septal thickening, and intralobular lines. The aim of this review is to describe the main clinical, imaging, and pathological aspects of Niemann-Pick disease, with a focus on pulmonary involvement.
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Adin ME, Onder H, Alabalık U. Echogenic splenic lesions in a child with type B Niemann-Pick disease. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41 Suppl 1:32-34. [PMID: 23124800 DOI: 10.1002/jcu.22009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 09/27/2012] [Indexed: 06/01/2023]
Abstract
We report the case of a 15-year-old boy with Niemann-Pick disease type B with characteristic sonographic findings of splenic involvement. There were multiple well-defined echogenic nodular lesions within the spleen parenchyma, and these lesions were surrounded by ring-like blood flow on color Doppler imaging. Most of the patients with Niemann-Pick disease type B are children and they undergo repeated imaging studies. Therefore, familiarity with sonographic findings of the disease is required.
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Affiliation(s)
- Mehmet Emin Adin
- Department of Radiology, Dicle University, School of Medicine, Diyarbakir 21280, Turkey
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Xiong H, Bao XH, Zhang YH, Xu YN, Qin J, Shi HP, Wu XR. Niemann-Pick disease type C: analysis of 7 patients. World J Pediatr 2012; 8:61-6. [PMID: 21633862 DOI: 10.1007/s12519-011-0284-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 09/13/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Niemann-Pick disease type C (NP-C), derived from mutation of the NPC1 or NPC2 gene, is one of the recessive lysosomal lipid storage disorders that are difficult to diagnose and treat. Since NP-C has been rarely reported in China, we reviewed 7 patients with NP-C. METHODS The 7 patients had been diagnosed with NP-C from 2007 to 2010 at our department and their laboratory and clinical data were analyzed. RESULTS The 7 patients, 5 males and 2 females, included 4 patients of late infantile subtype and 3 patients of juvenile subtype, in which patients 2 and 3 were siblings. Their clinical symptoms occurred from 4 to 10 years of age, exhibiting as progressive cognitive and language impairment as well as motor retrogression. Six patients were caught by focal or generalized seizures from 1 to 4 years after the onset of the disease. Vertical supranuclear gaze palsy, dysarthria, dysphagia, internal rotation and adduction of bilateral hands and splenomegaly occurred following the progress of clinical symptoms. Five patients had laughter-cataplexy. MRI showed mild brain atrophy in 6 patients. Reduction of total cholesterol, high density lipoprotein cholesterol and low density lipoprotein cholesterol occurred in 6 patients. Sea-blue cells and Niemann-Pick cells were found in bone marrow smears. The activity of acid sphingomyelin enzyme was normal or only slightly lower. Supporting or symptomatic treatment improved common clinical symptoms. CONCLUSIONS NP-C is a rare autosomal recessive inherited lysosomal storage disease that affects the intellectual development of children and may lead to dementia, vegetative state or death. Clinical features of this disease include vertical supranuclear gaze palsy, seizures and cataplexy. Laboratory features include abnormal plasma cholesterol level, and sea-blue cells and Niemann-Pick cells in bone marrow smears. The treatments of the disease include supporting or symptomatic administration.
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Affiliation(s)
- Hui Xiong
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
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Prasad C, Pushpanathan C, Morris R, Davis A, Dougherty F. Spectrum of phenotypic variability in Niemann-Pick type C disease: A cause of delayed diagnosis. Paediatr Child Health 2011; 3:329-33. [PMID: 20401275 DOI: 10.1093/pch/3.5.329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Niemann-Pick type C (NP-C) disease exhibits marked heterogeneity in its phenotype. This can pose diagnostic dilemmas and even delayed recognition of this condition. OBJECTIVE To highlight the phenotypic variations and distinctive pathological and biochemical findings in this disorder. DESIGN Descriptive case studies. SETTING Tertiary care children's hospital and clinic. POPULATION STUDIED Three cases of NP-C disease where diagnosis was delayed. RESULTS In each of the three cases the clinical presentation was varied, one as neonatal hepatitis, the second with megaloblastic anemia, chronic hepatitis and short stature, and the third with neonatal hepatitis and chronic respiratory failure. Definitive diagnosis was established in each case by demonstration of defective cholesterol esterification in skin fibroblasts. CONCLUSIONS In the clinical setting of neonatal hepatitis, hepatosplenomegaly and undiagnosed neurological symptoms, NP-C disease should be considered in the differential diagnosis. Electron microscopic examination of skin biopsy is an effective screening test, although the definitive diagnosis should be made by the cholesterol esterification assay and filipin staining.
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Benedetti E, Proietti A, Miccoli P, Basolo F, Ciancia E, Erba PA, Galimberti S, Orsitto E, Petrini M. Contrast-enhanced ultrasonography in nodular splenomegaly associated with type B Niemann-Pick disease: an atypical hemangioma enhancement pattern. J Ultrasound 2009; 12:85-92. [PMID: 23396497 DOI: 10.1016/j.jus.2009.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Niemann-Pick disease (NPD) types A and B are lipid storage disorders. NPD type A is a fatal disorder of infancy. Type B is a non-neuronopathic form observed in children and adults. It is associated with enlargement of the liver, spleen, or both, and nodular splenomegaly may be detected with ultrasound. METHODS A 21-year-old female was admitted to the Emergency Room with fever, pharyngitis, and left upper quadrant abdominal pain. Labwork revealed anemia, thrombocytopenia, increased levels of AST, ALT, GGT, AF, LDH, triglycerides, and total cholesterol and low levels of HDL-cholesterol. PCR blood assays for CMV and EBV were both negative. Chest X-ray was unremarkable. Transabdominal B-mode ultrasound (US) revealed splenomegaly (long axis: >22 cm), an irregular subcapsular hypoechoic lesion in the superior pole that was consistent with splenic infarction, and multiple round highly echogenic nodes measuring 1-5 cm in diameter. Contrast-enhanced ultrasonography (CEUS) was performed using SonoVue(®) (Bracco). RESULTS The presence of a splenic infarction was confirmed. The nodular lesions showed arterial-phase enhancement with late parenchymal phase wash-out. (18)F-FDG-PET revealed splenic nodular uptake. Primary splenic lymphoma was suspected, and the patient underwent open splenectomy. The diagnosis was type B NPD with splenic hemangiomas. DISCUSSION CEUS confirmed the diagnosis and extent of splenic infarction, but the nodular atypical enhancement pattern together with nodular (18)F-FDG-PET uptake was misleading, suggesting as it did lymphoproliferative involvement of the spleen.
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Affiliation(s)
- E Benedetti
- Department of Oncology, Transplantation, and New Advances in Medicine, Hematology Division, University of Pisa, Italy ; Italian Society of Ultrasound in Medicine and Biology, School of Basic and Emergency Ultrasonography, Italy
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Abstract
BACKGROUND Niemann-Pick disease, type C (NPC), is a lipid storage disease that may present at any age from fetal life to the seventh decade. Its protean manifestations include hepatic and pulmonary failure, as well as a range of progressive neuropsychiatric phenotypes. Late onset disease has been increasingly recognized as the biochemical diagnosis of NPC has been more widely applied. REVIEW SUMMARY The phenotypes, biochemical, and molecular bases of NPC are reviewed. Indistinguishable phenotypes are produced by mutations in two distinct genes, designated NPC 1 and NPC 2, that play key roles in the intracellular trafficking of lipids. The diagnosis of NPC is challenging as the characteristic vertical supranuclear gaze palsy is difficult to recognize, organomegaly is often absent, and standard biochemical screening studies are usually normal. Definitive diagnosis requires demonstration of the trafficking defect in cultured fibroblasts, supplemented in selected cases by genotyping. Animal studies have shown that inhibition of glycosphingolipid synthesis may delay the onset of disease and prolong survival; a human trial of this approach is underway. CONCLUSIONS NPC is a model for inborn errors of metabolism whose gene product mediates molecular trafficking rather than catabolizing macromolecules, as in classic lipid storage diseases. NPC should be considered in the differential diagnosis of progressive neurodegenerative disorders at any age. The astute clinician can provide great comfort to families afflicted by NPC by making an accurate diagnosis, notwithstanding the absence of definitive treatment.
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Affiliation(s)
- Marc C Patterson
- Division of Pediatric Neurology, Columbia University College of Physicians and Surgeons; Children's Hospital of New York and The Neurological Institute of New York, Harkness Pavilion, HP-542, 180 Fort Washington Avenue, New York, NY, USA
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Abstract
WE DESCRIBE FOUR PATIENTS WITH NIEMANN: Pick disease type C (NPC), in whom the presentation was isolated splenic enlargement; this remained the only abnormality for a number of years. Diagnosis can be suggested by either finding abnormal storage material in a tissue biopsy specimen or by showing a modest elevation in plasma chitotriosidase activity. In patients with suggestive abnormalities, filipin staining of a skin fibroblast sample should confirm the abnormality in cholesterol trafficking. Formal esterification studies and mutation analysis should also be performed, especially if prenatal testing is to be performed in subsequent pregnancies. If the diagnosis is not considered and established, the family are at risk of having further affected children. Investigation of patients with isolated splenomegaly is not complete until NPC has been excluded.
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Affiliation(s)
- J Imrie
- Willink Biochemical Genetics Unit, Royal Manchester Children's Hospital, Manchester M27 4HA, UK
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McCormick PA, Murphy KM. Splenomegaly, hypersplenism and coagulation abnormalities in liver disease. Best Pract Res Clin Gastroenterol 2000; 14:1009-31. [PMID: 11139352 DOI: 10.1053/bega.2000.0144] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Splenomegaly is a frequent finding in patients with liver disease. It is usually asymptomatic but may cause hypersplenism. Thrombocytopenia is the most frequent manifestation of hypersplenism and may contribute to portal hypertension related bleeding. A number of therapies are available for treating thrombocytopenia due to hypersplenism including splenectomy, partial splenectomy, partial splenic embolization, TIPS etc. None is entirely satisfactory. Hypersplenism usually improves following liver transplantation. Therapy with cytokines such as thrombopoietin may offer hope for the future. Patients with liver disease also have abnormalities in coagulation. This is not surprising as all coagulation proteins (except for von willebrand factor vWF) and most inhibitors of coagulation are synthesized in the liver. Genetic or acquired abnormalities of coagulation may predispose to thrombosis of the hepatic or portal veins with significant clinical sequelae. An understanding of the mechanisms involved in coagulation and thrombosis is valuable in choosing from the increasing treatment options available. These include clotting factors, haemeostatic drugs and newer therapies such as recombinant factor VIIa. Splenic artery aneurysms are the most common visceral artery aneurysms in man. Rupture is frequently catastrophic. These aneurysms are being increasingly recognized in liver transplant patients and require treatment before or during transplant surgery.
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Affiliation(s)
- P A McCormick
- St Vincent's University Hospital, Elm Park, Dublin, 4, Ireland
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