Acetazolamide treatment in late onset CDG type 1 due to biallelic pathogenic DHDDS variants

Pathogenic variants in DHDDS have been associated with either autosomal recessive retinitis pigmentosa or DHDDS-CDG. Heterozygous variants in DHDDS have been described in patients with a progressive neurodegenerative disease. Here we report on an individual presenting with a multisystem CDG phenotype who was diagnosed with known homozygous pathogenic DHDDS variants, previously associated with isolated retinitis pigmentosa.

An adult Ashkenazi Jewish female developed multiple symptoms of late onset type 1 CDG including seizures, ataxia, protein losing enteropathy, tremor, and titubation in association with elevated mono-oligo/di-oligo transferrin ratio in blood, and classic retinitis pigmentosa. She was diagnosed by whole exome sequencing with the common Ashkenazi Jewish, homozygous p.K42E variants in DHDDS. She was started on Acetazolamide and responded well to the treatment which improved her titubation, tremor, and generalized edema.

Reviewing the literature, families with DHDDS variants and multisystem presentation were different from our patient's presentation in terms of clinical manifestations, severity, genetic defect, and mode of inheritance. In previously reported patients with neurologic symptoms including seizures, movement abnormalities, and global development delay, the phenotype was caused by heterozygous pathogenic variants in DHDDS. The infant who was reported with a multisystem phenotype and fatal type 1 CDG had compound heterozygosity for a nonsense and a splice site variant in DHDDS, resulting in DHDDS-CDG.

The discovery of the novel phenotype associated with the common p.K42E pathogenic variant in DHDDS expands the spectrum of CDG and further enhances our understanding on the role of DHDDS in glycosylation beyond the retina.

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We report on the first individual carrying homozygous p.K42E variants in DHDDS associated with protein losing enteropathy, seizures, and ataxia.

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We observed familial variability in association with p.K42E and progressive ataxia in siblings with in DHDDS-CDG.

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The novel DHDDS-CDG patient phenotype broadens the current spectrum of CDG.

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Acetazolamide was successful in treating titubation and recurrent edema in our DHDDS-CDG patient of Ashkenazi Jewish descent.

Sarcoidosis presenting as a central nervous system mass lesion

Neurosarcoidosis occurs in approximately 5% of patients with systemic sarcoidosis. A review of medical literature shows that intracranial mass-like lesions secondary to sarcoidosis are quite rare. CT and MRI scanning would suggest that this manifestation of neurosarcoidosis may be more common than previously realized. We discuss five cases of neurosarcoidosis presenting as an intracranial mass. Empiric corticosteroid treatment can be recommended for cases with CNS mass in the context of systemic sarcoidosis.

Detection of transforming gene regions of human papillomavirus type 16 in cervical dysplasias by the polymerase chain reaction

In a study of 29 cases of histologically confirmed, characterized colposcopically and cytologically, cervical intraepithelial neoplasias 48.3% (14/29) of biopsies were positive for human papillomavirus (HPV) type 16 DNA by polymerase chain reaction. We used two oligonucleotide primer pairs (position 215-514 and 606-805) flanking a 300 and a 199 base pair fragment from the early 6 (E6) and early 7 (E7) genes. The results were concordant both with the E6 and with the E7 regions. Of the amplified products 85.7% (12/14) could be confirmed; these carried 16 specific sequences by Southern blot hybridization. HPV 16 DNA was present in 6.7% (2/30) of the colposcopically directed cytologically normal matched control samples using the same methods.

Pneumothorax and pulmonary cavitation in a man with systemic sarcoidosis

Sarcoidosis is a multisystem granulomatous disorder with protean manifestations. Physicians should be aware of potential unusual complications and this reminds one of the paradoxical affirmation that "rare events are always possible!" The case presented demonstrates two unusual consecutive complications: pneumothorax with lobar dissociation and primary acute pulmonary cavitation. Myocardium, liver and spleen were also involved. History and evolution suggest a relationship between sarcoid activity and alcohol consumption.