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Lambert LH, Shaikh N, Marx JL, Ramsey DJ. End-stage crystalline maculopathy with retinal atrophy in Sjögren-Larsson syndrome: a case report and review of the literature. THERAPEUTIC ADVANCES IN RARE DISEASE 2022; 3:26330040221122496. [PMID: 37180414 PMCID: PMC10032463 DOI: 10.1177/26330040221122496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/03/2022] [Indexed: 05/16/2023]
Abstract
Sjögren-Larsson syndrome (SLS) is a rare, autosomal recessive neurocutaneous disorder. It is caused by the inheritance of sequence variants in the ALDH3A2 gene, which codes for fatty aldehyde dehydrogenase (FALDH). Universal signs of the condition are congenital ichthyosis, spastic paresis of the lower and upper limbs, and reduced intellectual ability. In addition to this clinical triad, patients with SLS experience dry eyes and decreased visual acuity caused by a progressive retinal degeneration. Examination of the retina in patients with SLS often reveals glistening yellow crystal-like deposits surrounding the fovea. This crystalline retinopathy often develops in childhood and is considered pathognomonic for the disease. The metabolic disorder typically shortens lifespan to half that of the unaffected population. However, now that patients with SLS live longer, it becomes increasingly important to understand the natural course of the disease. Our case describes a 58-year-old woman with advanced SLS whose ophthalmic examination illustrates the end-stage of the retinal degeneration. Optical coherence tomography (OCT) and fluorescein angiography confirm the disease is restricted to the neural retina with dramatic thinning of the macula. This case is unique since it is among the most advanced both in terms of chronological age and severity of retinal disease. While the accumulation of fatty aldehydes, alcohols, and other precursor molecules is the probable cause of retinal toxicity, a more complete understanding of the course of retinal degeneration may aid in the development of future treatments. The aim of our presentation of this case is to increase awareness of the disease and to foster interest in therapeutic research which may benefit patients with this rare condition.
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Affiliation(s)
- Lester H. Lambert
- Department of Ophthalmology, Tufts University
School of Medicine, Boston, MA, USA
- Department of Surgery, Division of
Ophthalmology, Lahey Hospital & Medical Center, Burlington, MA,
USA
| | - Noreen Shaikh
- Department of Ophthalmology, Tufts University
School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Beth Israel
Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jeffrey L. Marx
- Department of Ophthalmology, Tufts University
School of Medicine, Boston, MA, USA
- Department of Surgery, Division of
Ophthalmology, Lahey Hospital & Medical Center, Burlington, MA,
USA
| | - David J. Ramsey
- Department of Ophthalmology, Tufts University
School of Medicine, Boston, MA, USA
- Department of Surgery, Division of
Ophthalmology, Lahey Hospital & Medical Center, 41 Mall Road,
Burlington, MA, 01803, USA
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Warrack S, Love T, Rizzo WB. A Neurodegenerative Phenotype Associated With Sjögren-Larsson Syndrome. J Child Neurol 2021; 36:1011-1016. [PMID: 34315315 PMCID: PMC8458237 DOI: 10.1177/08830738211029390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sjögren-Larsson syndrome (SLS) is a rare neurologic disorder caused by pathogenic sequence variants in ALDH3A2 and characterized by ichthyosis, spasticity, intellectual disability, and a crystalline retinopathy. Neurologic symptoms develop in the first 2 years of life. Except for worsening ambulation due to spastic diplegia and contractures, the neurologic disease has been considered static and a neurodegenerative course is distinctly unusual. We describe a young child with Sjögren-Larsson syndrome who exhibited an early and severely progressive neurologic phenotype that may have been triggered by a febrile rotavirus infection. Together with 7 additional published cases of these atypical patients, we emphasize that a neurodegenerative course can be an extreme outcome for a minority of patients with Sjögren-Larsson syndrome.
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Affiliation(s)
- Simone Warrack
- Department of Pediatrics, Child Health Research Institute, University of Nebraska Medical Center and Children’s Hospital & Medical Center, Omaha, NE, U.S.A
| | - Terri Love
- Department of Pediatrics, Child Health Research Institute, University of Nebraska Medical Center and Children’s Hospital & Medical Center, Omaha, NE, U.S.A
| | - William B. Rizzo
- Department of Pediatrics, Child Health Research Institute, University of Nebraska Medical Center and Children’s Hospital & Medical Center, Omaha, NE, U.S.A.,Direct correspondence to Dr. William Rizzo at 985940 Nebraska Medical Center, Omaha, Nebraska, 68198-5940, U.S.A. , Telephone: 402-559-2560, FAX: 402-559-2540
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Liu YD, Lin HJ, Li CY, Sun GF, Hu XB, Ma MY, Sun Y, Feng BZ, Li QB, Kong QX. Compound heterozygous mutations in the ALDH3A2 gene cause Sjögren-Larsson syndrome: a case report. Int J Neurosci 2020; 130:1156-1160. [PMID: 31944864 DOI: 10.1080/00207454.2020.1716750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Sjögren-Larsson syndrome is a rare, autosomal, recessive neurocutaneous disorder caused by mutations in the ALDH3A2 gene, which encodes the fatty aldehyde dehydrogenase enzyme. Deficiency in fatty aldehyde dehydrogenase results in an abnormal accumulation of toxic fatty aldehydes in the brain and skin, which cause spasticity, intellectual disability, ichthyosis, and other clinical manifestations. We present the clinical features and mutation analyses of a case of SLS.Materials and Methods: The family history and clinical data of the patient were collected. Genomic DNA was extracted from peripheral blood samples of the patient and her parents, and next-generation sequencing was performed. The candidate mutation sites that required further validation were then sequenced by Sanger sequencing. Bioinformatics software PSIPRED and RaptorX were used to predict the secondary and tertiary structures of proteins.Results: The patient, a five-year-old girl with complaints of cough for three days and intermittent convulsions for seven hours, was admitted to the hospital. Other clinical manifestations included spastic paraplegia, mental retardation, tooth defects, and ichthyosis. Brain magnetic resonance imaging showed periventricular leukomalacia. Genetic screening revealed compound heterozygous mutations in the ALDH3A2 gene: a frameshift mutation c.779delA (p.K260Rfs*6) and a missense mutation c.1157A > G (p.N386S). Neither of the ALDH3A2 alleles in the compound heterozygote patient were able to generate normal fatty aldehyde dehydrogenase, which were likely responsible for her phenotype of Sjögren-Larsson syndrome.Conclusion: The compound heterozygous mutations found in the ALDH3A2 gene support the diagnosis of Sjögren-Larsson syndrome in the patient and expand the genotype spectrum of the gene.
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Affiliation(s)
- Yi-Dan Liu
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China.,Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong, 272000, China.,Institute of Epilepsy, Jining Medical University, Jining, Shandong, 272000, China
| | - Hong-Juan Lin
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong, 272000, China
| | - Chun-Yan Li
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China.,Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong, 272000, China.,Institute of Epilepsy, Jining Medical University, Jining, Shandong, 272000, China
| | - Guang-Fei Sun
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, 272000, China
| | - Xi-Bin Hu
- Department of Imaging, Affiliated Hospital of Jining Medical University, Jining, Shandong, 272000, China
| | - Meng-Yu Ma
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China.,Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong, 272000, China.,Institute of Epilepsy, Jining Medical University, Jining, Shandong, 272000, China
| | - Ying Sun
- North China Medical Feng Feng General Hospital, Handan, Hebei, 056200, China
| | - Bang-Zhe Feng
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
| | - Qiu-Bo Li
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, 272000, China
| | - Qing-Xia Kong
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong, 272000, China.,Institute of Epilepsy, Jining Medical University, Jining, Shandong, 272000, China
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Fouzdar-Jain S, Suh DW, Rizzo WB. Sjögren-Larsson syndrome: a complex metabolic disease with a distinctive ocular phenotype. Ophthalmic Genet 2019; 40:298-308. [DOI: 10.1080/13816810.2019.1660379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Samiksha Fouzdar-Jain
- Department of Pediatrics and Child Health Research Institute, University of Nebraska Medical Center, Omaha, NE, USA
- Children’s Hospital & Medical Center, Omaha, NE, USA
- Department of Ophthalmology and Visual Science, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Donny W Suh
- Department of Pediatrics and Child Health Research Institute, University of Nebraska Medical Center, Omaha, NE, USA
- Children’s Hospital & Medical Center, Omaha, NE, USA
- Department of Ophthalmology and Visual Science, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - William B Rizzo
- Department of Pediatrics and Child Health Research Institute, University of Nebraska Medical Center, Omaha, NE, USA
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