Langjährige erfolglose Behandlung eines sekundären Lymphödems unter der Diagnose Acne inversa

Wir berichten über eine 48-jährige, deutlich adipöse Patientin, die über viele Jahre unter der Diagnose einer inguinalen Acne inversa erfolglos behandelt wurde. Wegen der hierfür untypischen Anamnese und Klinik, die eher für ein chronisches Lymphödem sprach, führten wir eine bildgebende Diagnostik des Bauchraumes durch. Hierbei fand sich eine monströse intraabdominelle, vermutlich benigne Raumforderung.

Klinische und Genotyp-Phänotyp-Korrelation epidemiologischer, bildgebender und neurologischer Befunde bei Patienten mit Morbus Wilson

Wilson's disease, a rare autosomal recessive disorder of hepatic copper transport, is characterized by a varying pattern of hepatic, neurologic and psychiatric symptoms. Currently, about 250 causative mutations of the ATP 7B gene are known. However, a correlation between genotype and phenotype according to these mutations is not yet clear. To elucidate a possible correlation in this study 39 patients with Wilson's disease were subdivided into three groups according to the underlying mutation in group I for homocygote respectively group II for compound heterocygote mutation in H1069Q and group III for other mutations. Clinical subtype and extent of neurologic disturbance as well as epidemiologic aspects, presence of psychiatric symptoms, results of acustically evoked potentials (Wave III, interpeak latency III-V) and findings of cranial MRI were considered. While psychopathological symptoms, the results of acustically evoked potentials and cranial MRI show a correlation to the clinical subtype of Wilson's disease there was no genotype-phenotype correlation on the basis of the mutation in H1069Q. The qualitative and quantitative pattern of results do not show any significant differences in the three groups of genotype. Thus, the time of treatment onset still has most influence on the extent of clinical manifestation and reversibility of the toxic copper accumulation.