Neonatal cholestasis as initial manifestation of type 2 gaucher disease: A continuum in the spectrum of early onset gaucher disease

Abdallah F. Elias, Maria Ronningen Johnson, John K. Boitnott, David Valle

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Gaucher disease type 2 [OMIM #230800] is a rare lysosomal storage disorder with usual onset between 3 and 6 months of age leading to progressive neurodegeneration and death within the first 2 years of life. Rarely it may lack the characteristic symptom-free period and initially manifest prenatally or in the neonatal period. The early course of neonatal onset classic type 2 variants is not well known, and reports of early histological changes in the liver of type 2 Gaucher disease patients are scarce. We describe a patient who presented in the immediate postnatal period with cholestasis without hepatomegaly associated with hepatocellular giant-cell transformation on liver biopsy, thrombocytopenia, and failure to thrive. This was initially thought to represent neonatal giant-cell hepatitis and the correct diagnosis was not made until the age of 6 months. Hepatocellular giant transformation has not been described in the classic acute neuronopathic form of GD. However, it has been reported in congenital GD with nonimmune hydrops and neonatal hepatitis, an example of perinatal lethal Gaucher disease (PLGD), which sometimes is regarded as an entity separate from GD type 2. Our case illustrates that neonatal cholestasis may be part of a spectrum of manifestations which spans a continuum between the PLGD and classic type 2 GD. Giant cells are a nonspecific finding but may reflect the presence of a systemic inflammatory process that recently has been implicated in the brain stem degeneration associated with acute neuronopathic GD.

Original languageEnglish (US)
Title of host publicationJIMD Reports
PublisherSpringer
Pages95-98
Number of pages4
DOIs
StatePublished - Jan 1 2012

Publication series

NameJIMD Reports
Volume5
ISSN (Print)2192-8304
ISSN (Electronic)2192-8312

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Keywords

  • Gauche cell
  • Gauche disease
  • Gauche disease type
  • Lysosomal storage disease
  • Neonatal hepatitis

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Biochemistry, Genetics and Molecular Biology (miscellaneous)

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