Sjogren- Larsson Syndrome with Type-1 Distal Renal Tubular Acidosis in Siblings

Abstract

Sjogren-Larsson syndrome (SLS) is a rare autosomal recessive lipid metabolic disorder caused because of the defect in fatty alcohol oxidation resulting from fatty aldehyde dehydrogenase (FALDH3A2) deficiency. Sjogren-Larsson syndrome is constituted by the trio of generalised spastic paralysis, intellectual impairment, & ichthyosis. The inability of hydrogen ions secretion from the distal tubule characterises dRTA (distal (Type 1) renal tubular acidosis). The dRTA aetiology is diverse, but it can be acquired or inherited. We report siblings who presented with congenital ichthyotic hyperkeratosis, spastic diplegia and severe learning disabilities, which were suggestive of SLS. Distal renal tubular acidosis diagnosis was done on the basis of severe serum hypokalaemia, urine electrolytes showing high potassium levels, metabolic acidosis with a positive anion gap, high pH of urine, Urinary & Blood PCO2 difference (UB PCO2) on the lower side, (FeHCO3%) showing mild bicarbonaturia (<5%), medullary nephrocalcinosis, Hypercalciuria as well as the omission of other differential diagnosis. Management in SLS was supportive. The child demonstrated symptomatic improvement after starting standard therapy for SLS & distal renal tubular acidosis. To conclude, distal renal tubular acidosis ailment in children can be controlled with a good long-term prognosis, but precise diagnosis as well as management are critical. Early detection can assist the physician in implementing appropriate supportive care as well as possible curative gene therapy. Keywords: Ichthyosis, spastic diplegia, Intellectual disability, Distal Renal Tubular Acidosis, Hypokalaemia