1
|
Nóbrega PR, Morais JLA, Ferreira AM, de Medeiros AD, Duarte BA, Rangel DM, Lima FO, de Paiva ARB, Paim-Marques L, Kok F, Pessoa ALS, Braga-Neto P, Carvalho FMM. Aseptic meningitis in Fabry disease due to a novel GLA variant: an expanded phenotype? Neurol Sci 2023; 44:319-327. [PMID: 36094773 DOI: 10.1007/s10072-022-06388-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/31/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND F abry disease (FD) is an X-linked lysosomal storage disorder with accumulation of globotriosylceramide, causing neurologic involvement mainly as acroparesthesias and cerebrovascular disease. Aseptic meningitis has been reported in 11 patients with FD, but no prior study has correlated alpha-galactosidase (GLA) specific variants with meningitis. We present in this manuscript a family in which a novel GLA pathogenic variant was associated with aseptic meningitis in 2 of 5 family members. METHODS This study began with identifying the proband, then screening family members for FD symptoms and evaluating symptomatic individuals for genetic and biochemical status. All patients underwent magnetic resonance imaging, and those with headache underwent cerebrospinal fluid (CSF) analysis. RESULTS Five patients (3 females) from a single family were included in this study. Mean age at diagnosis was 20.6 years. Two patients (40%) had aseptic meningitis; one of them also had cerebrovascular events. C-reactive protein and erythrocyte sedimentation rate were elevated during aseptic meningitis episodes. Both patients responded to intravenous methylprednisolone with resolution of fever, headache, and vomiting. One of them recurred and needed chronic immunosuppression with azathioprine. CONCLUSION We described aseptic meningitis in a family with a novel GLA variant. Meningitis might be a common phenomenon in FD and not a particularity of this variant. Understanding the mechanisms underlying meningitis and its association with cerebrovascular events may lead to a new paradigm of treatment for stroke in these patients. Further prospective studies with CSF collection in patients with FD and recurrent headache could help to elucidate this question.
Collapse
Affiliation(s)
- Paulo Ribeiro Nóbrega
- Division of Neurology, Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Brazil.,Neurogenetics Unit, Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Alliane Milliane Ferreira
- Neurology Department, Hospital Geral de Fortaleza, Ceará, Brazil.,Department of Clinical Medicine, Universidade de Fortaleza, Ceará, Brazil
| | - Alisson Dantas de Medeiros
- UNICHRISTUS University Center, Ceará, Brazil.,Neurology Department, Hospital Geral de Fortaleza, Ceará, Brazil
| | | | - Deborah Moreira Rangel
- Division of Neurology, Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Brazil.,Neurology Department, Hospital Geral de Fortaleza, Ceará, Brazil
| | | | | | | | - Fernando Kok
- Neurogenetics Unit, Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil.,Mendelics Genomic Analysis, São Paulo, Brazil
| | | | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, Brazil. .,Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Brazil.
| | - Fernanda Martins Maia Carvalho
- Neurology Department, Hospital Geral de Fortaleza, Ceará, Brazil.,Department of Clinical Medicine, Universidade de Fortaleza, Ceará, Brazil
| |
Collapse
|
2
|
Huang X, Zhang L, Huang J, Cai J. A Rare Cause of Young Stroke: What Rheumatologists Should Know about Fabry Disease. JOURNAL OF CLINICAL RHEUMATOLOGY AND IMMUNOLOGY 2021. [DOI: 10.1142/s2661341721720032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Systemic vasculitis is a category of autoinflammatory diseases usually involving multiple organs. Involvement of the central nervous system (CNS) may mimic other disorders, hence resulting in overdiagnosis. This is a case report of a young man who presented with acrodynia, episodic pyrexia, and recurrent strokes. He was treated for systemic vasculitis with glucocorticoids and immunosuppressants, which failed to prevent the stroke. Finally, Fabry disease was diagnosed after [Formula: see text]-galactosidase A gene mutation analysis was done. Rheumatologists should be aware of Fabry disease, which may present with multi-system involvement that mimics vasculitis. To avoid inappropriate treatment, a comprehensive differential diagnosis should be considered before a diagnosis of primary systemic vasculitis is made. Recurrent strokes, especially in males younger than 40, should raise suspicions of Fabry disease.
Collapse
Affiliation(s)
- Xiaoyan Huang
- Department of Rheumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518053, China
| | - Lijun Zhang
- Department of Rheumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518053, China
| | - Jinxian Huang
- Department of Rheumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518053, China
| | - Jifu Cai
- Department of Neurology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518053, China
| |
Collapse
|
3
|
Kraemer M, Berlit P. Primary central nervous system vasculitis - An update on diagnosis, differential diagnosis and treatment. J Neurol Sci 2021; 424:117422. [PMID: 33832773 DOI: 10.1016/j.jns.2021.117422] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/24/2020] [Accepted: 03/24/2021] [Indexed: 02/07/2023]
Abstract
IMPORTANCE Primary angiitis of the central nervous system (PACNS) is a rare condition which is often misdiagnosed. In order to avoid mistakes in the management, a step by step approach is necessary. OBSERVATIONS The most common presenting symptoms of PACNS are encephalopathy-related cognitive and affective abnormalities, headaches and multifocal symptoms associated with recurrent episodes of ischemia or hemorrhage. Seizures and spinal cord lesions may also occur. Diagnostic work up includes MRI, CSF examination, angiography and brain biopsy. Since all reported signs and findings lack specificity, the exclusion of differential diagnoses is essential before immunosuppressive therapy is started. Important differential diagnoses include reversible cerebral vasoconstriction syndrome, cerebral involvement of systemic vasculitides or rheumatic diseases, moyamoya angiopathy and infectious vasculopathies Effective treatment has been reported with glucocorticoids in combination with cyclophosphamide or rituximab; however, randomized clinical trials of PACNS treatment do not exist. CONCLUSIONS AND RELEVANCE PACNS is an important but rare differential diagnosis in daily neurological practice. The strict adherence to diagnostic criteria and the avoidance of inappropriate therapies in non-inflammatory vasculopathies and infectious diseases are essential.
Collapse
Affiliation(s)
- Markus Kraemer
- Department of Neurology, Alfried Krupp Hospital, Alfried-Krupp-Strasse 21, 45130 Essen, Germany; Department of Neurology, Medical Faculty, Heinrich Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany.
| | - Peter Berlit
- Department of Neurology, Alfried Krupp Hospital, Alfried-Krupp-Strasse 21, 45130 Essen, Germany; German Society of Neurology, Reinhardtstrasse 27 C, 10117 Berlin, Germany
| |
Collapse
|