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Pyruvate dehydrogenase-e1α deficiency presenting as recurrent demyelination: an unusual presentation and a novel mutation.
[pyruvate dehydrogenase deficiency]
The
nucleus-encoded
mitochondrial
pyruvate
dehydrogenase
enzyme
complex
plays
key
roles
in
cellular
energy
metabolism
and
acid-base
equilibrium
.
Pyruvate
dehydrogenase
complex
deficiency
is
due
to
loss
-of-function
mutation
in
one
of
the
five
component
enzymes
,
most
commonly
E
1
α-subunit
.
The
common
clinical
presentation
ranges
from
fatal
infantile
lactic
acidosis
in
newborns
to
chronic
neurological
dysfunction
.
We
describe
here
an
unusual
presentation
of
E
1
α-subunit
deficiency
presenting
as
recurrent
demyelination
,
Guillain-
Barré
syndrome
-like
demyelinating
polyneuropathy
at
the
onset
,
and
ophthalmoplegia
in
a
young
infant
.
The
clinical
phenotype
of
the
mutation
in
the
patient
was
unique
as
compared
to
the
previous
reported
cases
of
pyruvate
dehydrogenase
deficiency
.
The
mother
was
found
to
be
a
mosaic
carrier
of
the
mutation
.
This
phenotypic
variability
of
pyruvate
dehydrogenase
complex
deficiency
and
early
suspicion
of
its
unusual
neurological
manifestations
is
highlighted
.
Thiamine
and
ketogenic
diet
can
be
helpful
.
Diseases
Validation
Diseases presenting
"dehydrogenase deficiency"
symptom
adrenomyeloneuropathy
krabbe disease
pyruvate dehydrogenase deficiency
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