Abstract

Introduction: Arthrogryposis-renal dysfunctioncholestasis (Arc) syndrome is a rare multisystem disorder first described in 1979 and recently attributed to mutation in VPs33b, whose product acts in intracellular trafficking. It shows wide clinical variability. the characteristic features of Arc core phenotype include arthrogryposis, spillage of various substances in the urine, and conjugated hyperbilirubinemia. In some patients, these features are sometimes accompanied by different manifestations, such as ichthyosis, central nervous system malformation, deafness, and platelet abnormalities. Many patients with different associations of cholestasis, renal tubular acidosis, and dysmorphic morphology may be underdiagnosed. case report: We assessed the clinical characteristics of patients and investigated the VPs33b mutation in the gene G514s in a turkish patient with Arc syndrome. We reported one turkish patient with Arc syndrome, along with the presentations of renal tubular dysfunction, cholestasis, arthrogryposis, VPs33b Mutations in the gene G514s. conclusion: this case shows that the variability of different manifestations of Arc syndrome is well described.

Highlights

  • Hypereosinophilic syndrome (HES) can be a multisystem disorder due to direct end-organ damage by eosinophilia, and can rarely present with life-threatening features

  • We present a case of multi-organ failure secondary to eosinophilia related to medications

  • Case report: A 66-year-old woman with a recent diagnosis of asthma on montelukast, presented with excruciating pains of sudden onset in her lower limbs, and on admission, she was found to be in multi-organ failure

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Summary

INTRODUCTION

Eosinophilia refers to an absolute count of eosinophils >500/ml in the peripheral blood [1]. The patient described excruciating shooting pains in all muscle groups in her right leg, to the point that on presentation she was unable to weight bear, and had to be wheeled into the department. The patient was on montelukast 10 mg once daily and lansoprazole 30 mg once daily On further questioning, she admitted to having had recurrent chest infections and asthma exacerbations over the last few months prior to her current presentation, requiring steroids and antibiotics every 2–3 weeks. On further follow-up post-montelukast cessation and steroid withdraw, patient remained well and asymptomatic, with repeated bloods with normal blood count and eosinophilic values, having not required further treatment and in particular immunosuppression, making montelukast the main differential diagnosis for the patient’s life threatening presentation

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