Published online Nov 26, 2018. doi: 10.12998/wjcc.v6.i14.786
Peer-review started: August 17, 2018
First decision: September 11, 2018
Revised: October 10, 2018
Accepted: October 12, 2018
Article in press: October 11, 2018
Published online: November 26, 2018
Glutaric acidemia type II (GAII), also known as multiple acyl-CoA dehydrogenase deficiency, is an autosomal recessive inborn error of amino acid and fatty acid metabolism. We report a case of GAII with novel electron transfer flavoprotein (ETF)-A mutations in a 2-year-old female with thalassemia minor. The patient developed an episode of hypoglycemia and hypotonicity on the postnatal first day. Laboratory investigations revealed elevations of multiple acyl carnitines indicating glutaric acidemia type II in newborn screening analysis. Urinary organic acids were evaluated for the confirmation and revealed a high glutaric acid excretion. Genetic analysis revealed two novel mutations in the ETF-A gene, which are considered to be compound heterozygote. At the 8 mo of life ketone therapy was added, which significantly increased the neuromotor development. The patient had been closely followed for two years with carnitine, riboflavin, coenzyme Q10, and ketone supplementation in addition to a high carbohydrate diet. Although the patient had comorbidity like thalassemia minor, her neuromotor development was normal for her age and had no major health problems. This specific case expands the previously reported spectrum of this disease.
Core tip: Multiple acyl-CoA dehydrogenase deficiency (GAII) is an autosomal recessive inborn error of amino acid and fatty acid metabolism. We report a case of GAII with novel electron transfer flavoprotein (ETF)-A mutations in a 2-year-old female with thalassemia minor. Genetic analysis revealed two novel mutations in the ETF-A gene, which are considered to be the etiology for the disease. Most neonatal-onset patients of GAII may not survive due to progressive deterioration despite aggressive treatment. However, at 8 mo of age our patient, with the experimentally added ketone therapy, had no major health problems, and neuromotor development was normal for her age. The present case report is the only one reporting a patient with both GAII and thalassemia minor.