The Sjogren-Larsson syndrome in a north Indian sibship

Sjogren-Larsson syndrome

Sjogren-Larsson Syndrome is a rare autosomal disorder which occurs with 100% penetrance and is classically characterized by ichthyosis, spasticity and mental handicap. This has rarely been described in people of Indian origin, case reports mainly being restricted to Caucasians. We have described a 6-year-old girl with classical features of this syndrome, the symptoms having started in infancy. The spasticity is mainly diplegic in nature. Skin changes of ichthyosis are generalized and more in the flexural areas. Mental retardation is severe. Management is supportive.

Redefining the Sjögren-Larsson syndrome: atypical findings in three siblings and implications regarding diagnosis

BACKGROUND

The Sjögren-Larsson syndrome is a rare condition characterized by ichthyosis, spasticity, and mental retardation. Patients have deficient activity of the aldehyde portion of the fatty alcohol:nicotinamide adenine denucleotide (NAD+) oxidoreductase complex.

OBJECTIVE

Our purpose was to describe atypical findings in three siblings with the Sjögren-Larsson syndrome and implications regarding diagnosis.

METHODS

Medical histories were taken and physical examinations performed on four siblings and their parents. Analysis of fibroblast fatty alcohol:NAD+ oxidoreductase or fatty aldehyde dehydrogenase activity (or of both) was determined in each.

RESULTS

Decreased fibroblast fatty alcohol:NAD+ oxidoreductase or fatty aldehyde dehydrognase levels (or both) were present in three of four siblings. The fourth sibling and the parents had levels similar to obligate heterozygotes. None of the affected siblings fulfilled the classic criteria for the syndrome.

CONCLUSION

Although all affected siblings had abnormally low activity of the fatty alcohol:NAD+ dehydrogenase complex, their clinical findings were variable. This divergence of clinical features in siblings has not been previously reported. We propose that deficient activity of the fatty alcohol:NAD+ dehydrogenase complex be considered part of the definition of the Sjögren-Larsson syndrome that would also include the probable, but not absolute, presence of ichthyosis, mental retardation, and spasticity.