Clinical report: A patient with a late diagnosis of cerebrotendinous xanthomatosis and a response to treatment

Ahmad Alhariri, Katherine Hamilton, Vikash Oza, Kelly Cordoro, Nara Sobreira, Mary Malloy, Anne Slavotinek

Research output: Contribution to journalArticle

Abstract

Cerebrotendinous xanthomatosis (CTX) is a rare, autosomal recessive, inborn error of bile acid metabolism characterized by diarrhea in infancy, juvenile cataracts in childhood, tendon xanthomas developing in the second to third decades of life, and progressive neurologic dysfunction in adulthood. The condition is caused by mutations in the CYP27A1 gene that result in decreased production of chenodeoxycholic acid (CDCA) and elevated levels of cholestanol and bile alcohols. We present a 36-year-old male of Han ethnicity who developed xanthomas of his Achilles tendons and suffered neurocognitive declines and gait deterioration in his second decade. The diagnosis of CTX was confirmed by marked elevation of the serum cholestanol level. Sequencing of CYP27A1 showed a paternally inherited splice mutation, c.446 + 1G>T, and a maternally inherited nonsense mutation, c.808C>T, predicting p.(Arg270*). Despite the advanced disease in this patient, treatment with CDCA reduced the xanthoma size and improved his cognition and strength, and the patient made significant gains in his ambulation and coordination. We report this case to illustrate the potential benefits of therapy in patients with CTX who have advanced disease at the time of diagnosis.

Original languageEnglish (US)
Pages (from-to)2275-2279
Number of pages5
JournalAmerican Journal of Medical Genetics, Part A
Volume173
Issue number8
DOIs
StatePublished - Aug 1 2017

Keywords

  • bile acid metabolism
  • cerebrotendinous xanthomatosis
  • CYP27A1
  • inborn error of metabolism
  • leukodystrophy

ASJC Scopus subject areas

  • Genetics
  • Genetics(clinical)

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