Abstract
BackgroundNiemann-Pick type C (NPC) is a lysosomal lipid storage disease with mutation of NPC1/NPC2 genes, which transport lipids in the endosome and lysosome, and various neurological symptoms. NPC patients also develop hepatosplenomegaly or liver disorder in the neonatal period, and 10% suffer severe liver failure. Neonatal hemochromatosis (NH) is a liver disorder characterized by hepatic and extrahepatic siderosis. Although the etiology of NH is unclear, recent reports suggest that the gestational alloimmune mechanism is the cause of NH. Herein, we report a Japanese NPC patient initially diagnosed as NH. Case reportA 5-day-old boy was transferred to our hospital with severe cholestatic liver failure. Congenital infections and metabolic screening were negative, and NH was suspected. However intra and extrahepatic siderosis were not found. As his liver deteriorated rapidly, liver transplantation was performed at 19 days old. The explanted liver showed cirrhosis, and strong C5b-9 complex staining of hepatocytes, so NH was diagnosed. From the age of one and a half years, he developed regression, vertical supranuclear gaze palsy and cataplexy. Fibroblast filipin staining was strong, blood oxysterol was high, and there were compound heterozygous mutations in NPC1,p.[(F288L)];[(K1206N)]. The patient was then diagnosed as NPC and started on miglustat. ConclusionNeonatal liver failure was initially diagnosed as NH. Later, the patient developed various neurological symptoms characteristic of NPC. Neurological follow-up of children who develop NH is required.
Highlights
Niemann-Pick type C (NPC) is a lysosomal lipid storage disease with mutation of NPC1/NPC2 genes, which transport lipids in the endosome and lysosome, and various neurological symptoms
It is noteworthy in our case that the initial diagnosis of Neonatal hemochromatosis (NH) in the neonatal period had to be reconsidered as NPC after new neurological symptoms appeared
It was difficult to diagnose NPC in the neonatal period by liver pathology. Both diseases applied to the neonatal liver failure of our patient for definitive diagnosis as NH are diagnosed by pathological criteria and NPC is diagnosed by clinical symptoms and laboratory examinations
Summary
Neonatal NPC liver failure is likely to have similar clinical and pathological characteristics of NH caused by GALD. When NH is diagnosed, NPC should be ruled out because there is a specific treatment for neurological complications of NPC. For patients with neonatal liver disease, blood oxysterol measurement is useful for diagnosing NPC. Careful neurological follow-up of children who develop neonatal liver disease is required
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