Abstract

Pompe disease is a lysosomal storage disorder that results from an inborn error of metabolism which involves abnormal glycogen storage. Infantile-onset Pompe disease is the most severe phenotype that manifests with the findings of hypotonia, generalized muscle weakness, feeding difficulties, a failure to thrive, hearing loss, hypertrophic cardiomyopathy with systolic dysfunction, and respiratory distress. There is no effective treatment for Pompe disease and clinical control includes primary support health care. However, recent studies have reported that enzyme replacement therapy (ERT) can effectively decrease the symptoms or severity of the disease. The present study is a case report of a 24-day patient with infantile-onset Pompe disease who presented coughing and respiratory distress. The infant experienced fatigue during breastfeeding from the birth and developed dry and nonproductive coughs and perioral cyanosis from two weeks after the birth. The echocardiogram demonstrated left and right ventricular enlargement, mitral and tricuspid regurgitation, and pulmonary hypertension. After definitive diagnosis, the patient was administered with 20 mg/kg of alglucosidase 50 mg vial once every two weeks. He experienced significant improvement in body weight and echocardiogram and symptoms such as fatigue during breastfeeding and perioral cyanosis disappeared completely while he was under Myozyme treatment. In general, the observations confirmed the efficacy of Myozyme in a patient with infantile Pompe disease. Therefore, early diagnosis and quick treatment of Pompe disease with Myozyme can lead to acceptable outcomes, improve conditions, and finally, increase the chance of survival in these patients.

Highlights

  • Pompe disease, called type II glycogen storage disease, is a rare autosomal recessive inherited disease which is caused by the storage of glycogen in lysosome due to acid α-glucosidase (GAA) deficiency [1]

  • Infantile-onset Pompe disease may manifest in utero but more often is diagnosed at 3-4 months of age with the findings of hypotonia, generalized muscle weakness, feeding difficulties, a failure to thrive, hearing loss, hypertrophic cardiomyopathy with systolic dysfunction, and respiratory distress

  • Many diseases can be included in the differential diagnosis of Pompe disease such as idiopathic hypertrophic cardiomyopathy, myocarditis, spinal muscular atrophy type 1, and congenital muscular atrophy [10]

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Summary

Introduction

Called type II glycogen storage disease, is a rare autosomal recessive inherited disease which is caused by the storage of glycogen in lysosome due to acid α-glucosidase (GAA) deficiency [1]. Infantile-onset Pompe disease may manifest in utero but more often is diagnosed at 3-4 months of age with the findings of hypotonia, generalized muscle weakness, feeding difficulties, a failure to thrive, hearing loss, hypertrophic cardiomyopathy with systolic dysfunction, and respiratory distress. There is no effective treatment for Pompe disease and the clinical control only includes the primary support health care. The reported case is the first case of Pompe disease in Chaharmahal and Bakhtiari who underwent enzyme therapy with Myozyme and responded to the treatment. Asadpour and Bagheri-Kakolaki echocardiography was conducted by an adult cardiologist and the patient was referred to our center due to left and right ventricular enlargement, mitral and tricuspid regurgitation, and pulmonary hypertension. Regarding the symptoms and examinations results, the suspected diagnosis was Pompe disease. The pulmonary pressure of 50 mm Hg decreased to 30 mm Hg and the administration of drugs was discontinued and the symptoms such as fatigue during breastfeeding and perioral cyanosis disappeared completely

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