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First Chinese case of successful pregnancy with combined methylmalonic aciduria and homocystinuria, cblC type.
[homocystinuria without methylmalonic aciduria]
Objective
:
Combined
methylmalonic
aciduria
(
MMA
)
and
homocystinuria
,
cblC
type
,
is
the
most
common
MMA
in
Mainland
China
.
Its
clinical
spectrum
varies
from
severe
neonatal
-onset
forms
with
brain
injury
and
high
mortality
to
milder
forms
with
late
onset
.
Timely
diagnosis
and
adequate
treatment
greatly
improve
the
prognosis
.
In
the
past
15
years
,
many
Chinese
patients
with
this
condition
have
achieved
favorable
treatment
outcomes
,
and
some
of
them
have
reached
childbearing
age
.
Here
,
we
report
the
first
case
of
Chinese
woman
with
cblC
undergoing
a
successful
pregnancy
and
delivering
a
healthy
boy
.
Methods
:
A
patient
of
late-onset
cblC
,
who
achieved
successful
pregnancy
and
delivery
of
a
healthy
boy
,
was
enrolled
in
our
studies
.
The
patient
and
her
disease
characteristics
were
analyzed
,
including
age
at
onset
,
age
at
diagnosis
,
clinical
presentation
,
clinical
classification
,
family
history
,
laboratory
findings
and
MMACHC
gene
mutation
.
Results
:
Our
patient
presented
mild
neurological
symptoms
at
the
age
of
15
years
.
She
had
the
compound
heterozygous
mutations
,
c
.
315
C
>
G
and
c
.
482
G
>
A
,
on
the
MMACHC
gene
.
After
long
-term
treatment
with
cobalamin
,
calcium
folinate
,
l-carnitine
and
betaine
,
along
with
normal
diet
,
she
recovered
completely
.
At
age
23
,
she
visited
us
for
genetic
counseling
and
fetal
evaluation
at
15
weeks
of
gestation
.
Her
general
condition
and
the
fetal
growth
were
normal
.
At
20
weeks
of
gestation
,
intramuscular
cobalamin
was
changed
to
pure
hydroxocobalamin
(
1
mg
,
every
other
day
)
because
of
markedly
elevated
urine
MMA
and
plasma
total
homocysteine
.
In
addition
,
the
dosages
of
l-carnitine
(
1
g
,
p
.
o
.
,
tds
)
,
folic
acid
(
5
mg
,
p
.
o
.
,
tds
)
and
betaine
(
1
g
,
p
.
o
.
,
tds
)
were
increased
.
Protein
intake
was
not
restricted
.
Conclusions
:
This
is
the
first
report
of
a
Chinese
woman
with
cblC
,
undergoing
a
successful
pregnancy
and
delivering
a
healthy
baby
at
term
.
The
favorable
outcome
of
the
patient
and
her
fetus
should
owe
much
to
the
mild
phenotype
of
her
disease
.
Diseases
Validation
Diseases presenting
"first case"
symptom
achondroplasia
adrenal incidentaloma
allergic bronchopulmonary aspergillosis
alpha-thalassemia
aniridia
aromatase deficiency
canavan disease
carcinoma of the gallbladder
child syndrome
cholangiocarcinoma
classical phenylketonuria
coats disease
cohen syndrome
congenital toxoplasmosis
cushing syndrome
cutaneous mastocytosis
dedifferentiated liposarcoma
dentin dysplasia
dracunculiasis
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
esophageal adenocarcinoma
esophageal carcinoma
fabry disease
familial mediterranean fever
focal myositis
gm1 gangliosidosis
harlequin ichthyosis
hodgkin lymphoma, classical
homocystinuria without methylmalonic aciduria
junctional epidermolysis bullosa
kabuki syndrome
krabbe disease
lamellar ichthyosis
legionellosis
liposarcoma
locked-in syndrome
malignant atrophic papulosis
monosomy 21
neonatal adrenoleukodystrophy
oculocutaneous albinism
omenn syndrome
papillon-lefèvre syndrome
pendred syndrome
pleomorphic liposarcoma
primary effusion lymphoma
primary hyperoxaluria type 1
proteus syndrome
pyomyositis
systemic capillary leak syndrome
thoracic outlet syndrome
von hippel-lindau disease
waldenström macroglobulinemia
well-differentiated liposarcoma
werner syndrome
wolf-hirschhorn syndrome
x-linked adrenoleukodystrophy
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