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Arslan S, Abuşoğlu Y, Altınkaynak K, Kahveci H. Exchange Transfusion: A Good Option for the Acute Treatment of Familial Chylomicronemia Syndrome in the Neonatal Period. Cureus 2024; 16:e57019. [PMID: 38681269 PMCID: PMC11046373 DOI: 10.7759/cureus.57019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Familial chylomicronemia syndrome (FCS) is one of the rare causes of hypertriglyceridemia. Plasmapheresis is recommended in patients with triglyceride levels greater than 2000 mg/dL. However, plasmapheresis is difficult to perform in most centers due to technical inadequacies in the neonatal period. There are some reports in the literature on the efficacy of exchange transfusion. The index case involves a 20-day-old male patient who was admitted to the emergency department for restlessness and poor feeding. He was born at term with a birth weight of 4000 g. He was exclusively breastfed. The patient was taken to the neonatal intensive care unit due to his plasma being in the form of excessive lipemia. The first measurable triglyceride level was 5100 mg/dL (57.6 mmol/L). Breast milk was restricted, and intravenous hydration was started. However, his triglyceride level did not decrease despite this treatment. Other laboratory values could not be read due to excessive lipemic serum. On the third day of hospitalization, an exchange transfusion was decided upon in this case due to the development of respiratory distress (oxygen support, tachypnea). After exchange transfusion, the patient's triglyceride level reduced dramatically to 592 mg/dL (6.6 mmol/L), and his respiratory symptoms resolved. The aim of this case report is to demonstrate that exchange transfusion therapy is a safe and effective treatment modality in the neonatal period for the acute management of FCS. Furthermore, dietary therapy restricted to long-chain fatty acids combined with medium-chain fatty acid supplementation is highly effective in the chronic management of these patients.
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Affiliation(s)
- Sezai Arslan
- Department of Inherited Metabolic Diseases, Erzurum City Hospital, Erzurum, TUR
| | - Yasemin Abuşoğlu
- Department of Nutrition and Dietetics, Erzurum City Hospital, Erzurum, TUR
| | - Konca Altınkaynak
- Department of Medical Biochemistry, University of Health Sciences Erzurum Medical Faculty, Erzurum, TUR
| | - Hasan Kahveci
- Department of Neonatology, University of Health Sciences Erzurum Medical Faculty, Erzurum, TUR
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Aly R, Acharya R, Upadhyay KK. Severe hypertriglyceridemia in an infant on chronic hemodialysis. Hemodial Int 2023; 27:E1-E4. [PMID: 36259088 DOI: 10.1111/hdi.13049] [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: 05/25/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 01/10/2023]
Abstract
Severe hyperlipidemia is a risk factor for cardiovascular disease. Children with chronic kidney disease and end stage renal disease are at risk for development of hyperlipidemia. In this report, we describe a 7-month-old male infant with Denys-Drash syndrome who was found to have a "milky-layer" floating on the deaerator of the hemodialysis machine. Investigations showed severe hypertriglyceridemia of >1000 mg/dl. The patient had been on chronic continuous manual peritoneal dialysis until 6 months of age and recently had been switched to hemodialysis. Management included lowering of caloric intake and addition of medium chain triglyceride with reduction of the serum triglyceride levels to 300-400 mg/dl. Close monitoring of serum lipids and timely intervention is important to prevent serious complications associated with dyslipidemia. Observation of the "milky layer" in the deaerator of the hemodialysis machine may be an interesting visual clue of underlying severe hypertriglyceridemia.
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Affiliation(s)
- Rasha Aly
- Division of Pediatric Nephrology, Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Ratna Acharya
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Kiran K Upadhyay
- Division of Pediatric Nephrology, Department of Pediatrics, University of Florida, Gainesville, Florida, USA
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Huang Y, Qin Y, Liao L, Lin F. Familial chylomicronemia syndrome caused by compound heterozygous mutation of lipoprotein lipase gene: A case report and review of literature. Clin Chim Acta 2022; 537:112-117. [DOI: 10.1016/j.cca.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022]
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Han L, Qiang G, Yang L, Kou R, Li Q, Xin M, Liu R, Zhang Z. Plasma exchange therapy for familial chylomicronemia syndrome in infant: A case report. Medicine (Baltimore) 2022; 101:e29689. [PMID: 35960041 PMCID: PMC9371531 DOI: 10.1097/md.0000000000029689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Familial chylomicronemia syndrome (FCS) is a rare genetic disease. FCS usually manifests by the age of 10 years, and 25% of cases of FCS occur during infancy. Here we present a case of FCS in a male infant and summarize our experiences on the diagnosis and therapy of this case. PATIENT CONCERNS A male infant aged 1 month and 8 days had recurrent hematochezia and hyperchylomicronemia. DIAGNOSIS FCS based on symptoms and genetic test. INTERVENTIONS Plasma exchange therapy. OUTCOMES His development was normal with a good spirit and satisfactory weight gain, and no hematochezia occurred again. CONCLUSION Genetic test is important for accurate diagnosis of FCS, and we identified a new mutation of lipoprotein lipase gene c.88C>A which conformed to autosomal recessive inheritance. Plasma exchange therapy can be applied to infants with FCS with low risk and good outcomes.
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Affiliation(s)
- Lei Han
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Guangfeng Qiang
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Lei Yang
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Rui Kou
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Qiubo Li
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Meiyun Xin
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Ruihan Liu
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Zhengjun Zhang
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining, China
- * Correspondence: Zhengjun Zhang, Department of Endocrinology, Affiliated Hospital of Jining Medical University, Tianjinfu St, Jining, 272001 Shandong, China (e-mail: )
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El-Koofy NM, Abdo YA, El-Fayoumi D, Esmael AF, Elmonem MA, Ezzeldin Z. Management strategy and novel ophthalmological findings in neonatal severe hypertriglyceridemia: a case report and literature review. Lipids Health Dis 2021; 20:38. [PMID: 33879184 PMCID: PMC8058978 DOI: 10.1186/s12944-021-01464-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/12/2021] [Indexed: 12/22/2022] Open
Abstract
Background Neonatal severe hypertriglyceridemia is rarely reported in the literature and there is no consensus for hypertriglyceridemia management at this age group. Methods The index case is a 4-week-old male infant with severe hypertriglyceridemia accidentally discovered during a circumcision surgery. His clinical and genetic characteristics and his successful management strategy are described. Furthermore, a detailed ophthalmological examination of the proband was conducted at 3 and 6 months of age using Fourier-domain-optical coherence tomography. Results Triglycerides level at presentation was extremely high 33,727 mg/dL (380.8 mmol/L). Two sessions of exchange blood transfusion on two consecutive days successfully reduced triglycerides to 382 mg/dL (4.3 mmol/L) with no adverse effects. The infant was discharged 3 days later. At discharge, the mother was advised to continue breastfeeding together with a medium-chain triglycerides formula. Satisfactory growth parameters and lipid profile values were obtained for a follow-up duration of 5 months with no reported attacks of acute pancreatitis. Lipoprotein lipase deficiency was confirmed by the detection of the LPL homozygous pathogenic variant c.805G > A; p.(Glu269Lys). Early corneal and macular lesions were detected and persisted on follow-up despite relatively good lipemic control. Conclusion This case highlights the importance of the early discovery of severe hypertriglyceridemia during the neonatal period, which is needed for prompt management and prevention of severe complications. Rationalized breastfeeding can be tolerated within the diet plan of the disease with satisfactory outcomes. To our knowledge, it is the first study reporting early corneal and macular affection by severe hypertriglyceridemia in a neonate. Prolonged follow-up is needed to determine the extent of ophthalmological lesions.
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Affiliation(s)
- Nehal M El-Koofy
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasmeen A Abdo
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina El-Fayoumi
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amanne F Esmael
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A Elmonem
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Center of Social and Preventive Medicine, Cairo University, 2 Ali Pasha Ibrahim Street, Room 409, Monira, Cairo, 11628, Egypt.
| | - Zahraa Ezzeldin
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
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Peter R, Shreeshruthi B, Saravanan G, Subburaman VS. A case of milky serum in neonate with rare mutation of lipoprotein lipase. J Clin Neonatol 2021. [DOI: 10.4103/jcn.jcn_129_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Poon S, Leung K, Tung J. Management of severe hypertriglyceridemia due to lipoprotein lipase deficiency in children. Endocrinol Diabetes Metab Case Rep 2019; 2019:1-5. [PMID: 31352695 PMCID: PMC6685095 DOI: 10.1530/edm-19-0052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Summary Severe hypertriglyceridemia is an endocrine emergency and is associated with acute pancreatitis and hyperviscosity syndrome. We describe an infant with lipoprotein lipase deficiency with severe hypertriglyceridemia who presented with acute pancreatitis. She was managed acutely with fasting and intravenous insulin infusion, followed by low-fat diet with no pharmacological agent. Subsequent follow-up until the age of 5 years showed satisfactory lipid profile and she has normal growth and development. Learning Points Hypertriglyceridemia-induced acute pancreatitis has significant morbidity and mortality, and prompt treatment is imperative.
When no secondary causes are readily identified, genetic evaluation should be pursued in hypertriglyceridemia in children.
Intravenous insulin is a safe and effective acute treatment for hypertriglyceridemia in children, even in infants.
Long-term management with dietary modifications alone could be effective for primary hypertriglyceridemia due to lipoprotein lipase deficiency, at least in early childhood phase.
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Affiliation(s)
- Sarah Poon
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - Karen Leung
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
| | - Joanna Tung
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong
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Dabas G, Guliani A, Handa S, Aggarwal D, Radotra BD. Infant with multiple yellow papules: Foreshadowing systemic disease. J Paediatr Child Health 2019; 55:484-485. [PMID: 30957333 DOI: 10.1111/jpc.14396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Garima Dabas
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research Chandigarh, India
| | - Ankur Guliani
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research Chandigarh, India
| | - Sanjeev Handa
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research Chandigarh, India
| | - Divya Aggarwal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research Chandigarh, India
| | - Bishan D Radotra
- Department of Histopathology, Postgraduate Institute of Medical Education and Research Chandigarh, India
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