Antoine Cossette1, Julie Castilloux2, Chantal Bouffard3, Julie Laflamme4, Christophe Faure5, Sami Benlamlih1, Florian Abel6, Michael Beecroft6, Mira Francis6, Régen Drouin7. 1. ULaval, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada. 2. Pediatric Gastroenterology Division, Department of Pediatrics, CHU de Québec - ULaval, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada. 3. Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine and Health Sciences, CHUS Research Center, Université de Sherbrooke, Sherbrooke, Quebec, Canada. 4. Pediatric Palliative Care Division, Department of Pediatrics, CHU de Québec - ULaval, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada. 5. Pediatric Gastroenterology, Sainte-Justine Hospital, Montréal, Quebec, Canada. 6. Alexion Pharmaceuticals, Inc, Boston, Massachusetts, USA. 7. Division of Medical Genetics, Department of Pediatrics, CHU de Québec - ULaval, and Research Center of the CHU de Québec - ULaval, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada.
Abstract
Background: This report describes a unique case of long-term survival of a young girl who was diagnosed with severe, rapidly progressive lysosomal acid lipase deficiency (LAL-D; historically "Wolman disease") at three months of age and began receiving therapeutic interventions at four months of age. This disease involves rapidly progressive multisystemic impairments and limited survival (6-12 months) without treatment. Methods: Case report taking into account clinical aspects and patient management including a semi-structured interview with the main family caregiver. Results: Presentation at two months of age: severe malnutrition and chronic diarrhea; hypoalbuminemia; low iron, vitamin A, and vitamin D levels; high triglyceride levels; profound anemia; thrombocytopenia; adrenal calcifications; and mild hepatosplenomegaly. Enzyme replacement therapy (ERT) with sebelipase alfa, parenteral nutrition, and a low-fat diet began at age four months. The patient has received sebelipase alfa for >5 years with good tolerability and is thriving, with a body mass index of 16.35 kg/m2 (80th percentile) despite a stature delay (height <3rd percentile), and mild developmental delay. Optimal medical management requires that family caregivers and health professionals have the knowledge and skills to provide appropriate care and supports multidisciplinary teams through transfer of knowledge to all stakeholders. Effective coordination of services and activities related to child health and development, including navigation of administrative and financial barriers, is also imperative. Conclusions: Formerly fatal in untreated infants, severe LAL-D, when diagnosed early, can be promptly and effectively treated by combining sebelipase alfa ERT, modified diet, involvement of family caregivers, and multidisciplinary team collaboration.
Background: This report describes a unique case of long-term survival of a young girl who was diagnosed with severe, rapidly progressive lysosomal acid lipase deficiency (LAL-D; historically "Wolman disease") at three months of age and began receiving therapeutic interventions at four months of age. This disease involves rapidly progressive multisystemic impairments and limited survival (6-12 months) without treatment. Methods: Case report taking into account clinical aspects and patient management including a semi-structured interview with the main family caregiver. Results: Presentation at two months of age: severe malnutrition and chronic diarrhea; hypoalbuminemia; low iron, vitamin A, and vitamin D levels; high triglyceride levels; profound anemia; thrombocytopenia; adrenal calcifications; and mild hepatosplenomegaly. Enzyme replacement therapy (ERT) with sebelipase alfa, parenteral nutrition, and a low-fat diet began at age four months. The patient has received sebelipase alfa for >5 years with good tolerability and is thriving, with a body mass index of 16.35 kg/m2 (80th percentile) despite a stature delay (height <3rd percentile), and mild developmental delay. Optimal medical management requires that family caregivers and health professionals have the knowledge and skills to provide appropriate care and supports multidisciplinary teams through transfer of knowledge to all stakeholders. Effective coordination of services and activities related to child health and development, including navigation of administrative and financial barriers, is also imperative. Conclusions: Formerly fatal in untreated infants, severe LAL-D, when diagnosed early, can be promptly and effectively treated by combining sebelipase alfa ERT, modified diet, involvement of family caregivers, and multidisciplinary team collaboration.
Authors: Simon A Jones; Vassili Valayannopoulos; Eugene Schneider; Stephen Eckert; Maryam Banikazemi; Martin Bialer; Stephen Cederbaum; Alicia Chan; Anil Dhawan; Maja Di Rocco; Jennifer Domm; Gregory M Enns; David Finegold; J Jay Gargus; Ornella Guardamagna; Christian Hendriksz; Iman G Mahmoud; Julian Raiman; Laila A Selim; Chester B Whitley; Osama Zaki; Anthony G Quinn Journal: Genet Med Date: 2015-08-27 Impact factor: 8.822