Hepatosplenomegaly, pneumopathy, bone changes and fronto-temporal dementia: Niemann-Pick type B and SQSTM1-associated Paget's disease in the same individual.

Détails

ID Serval
serval:BIB_11FF7C377058
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Lettre (letter): communication adressée à l'éditeur.
Collection
Publications
Titre
Hepatosplenomegaly, pneumopathy, bone changes and fronto-temporal dementia: Niemann-Pick type B and SQSTM1-associated Paget's disease in the same individual.
Périodique
Journal of bone and mineral metabolism
Auteur(s)
Voinea C., Gonzalez Rodriguez E., Beigelman-Aubry C., Leroy V., Aubry-Rozier B., Campos-Xavier B., Ballhausen D., Lazor R., Barbey F., Bonafé L., Superti-Furga A., Tran C.
ISSN
1435-5604 (Electronic)
ISSN-L
0914-8779
Statut éditorial
Publié
Date de publication
03/2019
Peer-reviewed
Oui
Volume
37
Numéro
2
Pages
378-383
Langue
anglais
Notes
Publication types: Case Reports ; Letter
Publication Status: ppublish
Résumé
Data from exome sequencing show that a proportion of individuals in whom a genetic disorder is suspected turn out to have not one, but two to four distinct ones. This may require an evolution in our diagnostic attitude towards individuals with complex disorders. We report a patient with splenomegaly, pneumopathy, bone changes and fronto-temporal dementia (FTD). "Sea-blue histiocytes" in his bone marrow pointed to a lysosomal storage disease. Homozygosity for a pathogenic mutation in the SMPD1 gene confirmed Niemann-Pick disease type B (NPD-B). Mild cognitive impairment and abnormal brain FDG PET were consistent with FTD. We initially tried to fit the skeletal and neurologic phenotype into the NPD-B diagnosis. However, additional studies revealed a pathogenic mutation in the SQSTM1 gene. Thus, our patient had two distinct diseases; NPD-B, and Paget's disease of bone with FTD. The subsequent finding of a mutation in SQSTM1 gene ended our struggle to explain the combination of findings by a singular "unifying" diagnosis and allowed us to make specific therapeutic decisions. SQSTM1 mutations have been reported in association with FTD, possibly because of defective autophagy. Bisphosphonates may be beneficial for PDB, but since they are known to inhibit acid sphingomyelinase activity, we refrained from using them in this patient. While the principle of looking for unifying diagnosis remains valid, physicians should consider the possibility of co-existing multiple diagnoses when clinical features are difficult to explain by a single one. Accurate diagnostic work-up can guide genetic counseling but also lead to better medical management.
Mots-clé
Bone Marrow/pathology, Bone and Bones/pathology, Frontotemporal Dementia/complications, Hepatomegaly/complications, Humans, Male, Middle Aged, Niemann-Pick Disease, Type B/complications, Niemann-Pick Disease, Type B/diagnostic imaging, Osteitis Deformans/complications, Osteitis Deformans/diagnostic imaging, Sequestosome-1 Protein/genetics, Splenomegaly/complications, Tomography, X-Ray Computed, Acid sphingomyelinase, Interstitial pulmonary disease, Lysosomal storage disease, Niemann–Pick type B, Paget’s disease of bone
Pubmed
Web of science
Création de la notice
29/06/2018 17:10
Dernière modification de la notice
20/08/2019 13:39
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