■先天性葡萄糖-半乳糖吸收不良(CGGM)是一种罕见的常染色体隐性遗传疾病,主要引起慢性顽固性腹泻。本研究旨在描述临床病史,实验室简介,诊断工作流,以及墨西哥首例CGGM患者的治疗。
该病例涉及一名墨西哥女婴,自出生以来因慢性腹泻反复入院急诊室。
■婴儿在足月剖腹产时出生,出生体重为3.120公斤,近亲的身高为48厘米。她一直被母乳喂养,直到她生命的第五天,她表现出嗜睡,腹泻,腹部不适,和黄疸。在急诊室的第一次评估中,重要的实验室发现是血液酪氨酸升高;之后,获得了氨基酸和琥珀酰丙酮的测定结果,丢弃酪氨酸血症。入院时,腹部超声检测到双工采集系统。此时,向病人介绍了大米配方。她因黄疸改善而出院,但腹泻持续。从大米到广泛水解的酪蛋白到基于乳清的蛋白质,已经进行了一些配方更改,没有临床改善;患者每天仍有10-12个排泄物。在第二次住院时,病人出现贫血,严重脱水,高氨血症,和肾小管酸中毒.进行了先天性代谢错误和先天性腹泻的下一代测序小组,鉴定SLC5A1中的纯合变体(c.1667T>C)。CGGM的诊断是在3月龄时做出的。婴儿最初用模块化的无半乳糖-葡萄糖配方油治疗,果糖,酪蛋白,矿物,和维生素,直到引入商业果糖配方。这导致腹泻的完全缓解和营养状况的改善。
■诊断CGGM对临床医生来说是具有挑战性的,下一代测序是提供适当治疗的有价值的工具。有关这种情况的患者的更详细信息可能导致可能的表型-基因型相关性。该病例的主要临床和生化检查结果为慢性腹泻,贫血,黄疸,肾小管性酸中毒,高氨血症,和最初的高酪氨酸血症。用基于果糖的配方完全解决了症状。
UNASSIGNED: Congenital glucose-galactose malabsorption (CGGM) is a rare autosomal recessive disorder that primarily causes chronic intractable diarrhea. This study aims to describe the clinical history, laboratory profile, diagnostic workflow, and management of the first patient reported with CGGM in Mexico.
UNASSIGNED: The
case involves a Mexican female infant with recurrent admissions to the emergency room since birth due to chronic diarrhea.
UNASSIGNED: The infant was born at term by C-section with a birth weight of 3.120 kg and height of 48 cm for consanguineous parents. She had been breastfed until day 5 of her life when she presented lethargy, diarrhea, abdominal discomfort, and jaundice. During the first evaluation at the emergency room, the significant laboratory finding was blood tyrosine elevation; afterward, amino acid and succinylacetone determinations were obtained, discarding tyrosinemia. When admitted to the hospital, an abdominal ultrasound detected a duplex collecting system. At this time, rice formula was introduced to the patient. She was discharged with jaundice improvement, but diarrhea persisted. Several formula changes had been made from rice to extensively hydrolyzed casein protein to whey-based, with no clinical improvement; the patient still had 10-12 excretions daily. In the second hospitalization, the patient presented anemia, severe dehydration, hyperammonemia, and renal tubular acidosis. A next-generation sequencing panel for inborn errors of metabolism and congenital diarrhea was performed, identifying a homozygous variant in SLC5A1 (c.1667T > C). The diagnosis of CGGM was made at 3 months of age. The infant was initially treated with a modular galactose-glucose-free formula with oil, fructose, casein, minerals, and vitamins until a commercial fructose-based formula was introduced. This led to a complete resolution of diarrhea and improved nutritional status.
UNASSIGNED: Diagnosing CGGM is challenging for clinicians, and next-generation sequencing is a valuable tool for providing appropriate treatment. More detailed information on patients with this condition might lead to possible phenotype-genotype correlations. This
case\'s primary clinical and biochemical findings were chronic diarrhea, anemia, jaundice, renal tubular acidosis, hyperammonemia, and initial hypertyrosinemia. Symptoms were resolved entirely with the fructose-based formula.