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Zhang T, Zhang X, Zhang N, Yan J, Wang L, Yan W, Yu Z, Zhang Y, Duan Y, Zhang R. A case of gaucher disease with a rare complication of gaucheroma and protein-losing enteropathy. Mol Genet Metab Rep 2024; 39:101075. [PMID: 38571878 PMCID: PMC10988120 DOI: 10.1016/j.ymgmr.2024.101075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
This case report describes a patient initially diagnosed with Gaucher disease (GD) with type I with homozygous mutation c.1448T > C p. (Leu483Pro) at age of 2, presenting with hepatosplenomegaly and cytopenia. Imiglucerase replacement therapy was initiated. At age 17, bilateral hearing loss developed, with subsequent Cranial MRI revealing thalamic damage, leading to a reclassification as type 3 GD. By age of 20, the patient presented with a range of symptoms, including abdominal pain, diarrhea, hypoproteinemia, multiple lymphadenopathy, edema, and Gaucher cell infiltration in the lymph nodes. Comprehensive diagnosis identifies Gaucher tumor and protein-losing enteropathy. Imiglucerase therapy at 90-120 U/kg every 2 weeks significantly improved clinical symptoms, emphasizing the importance of tailored interventions for managing GD manifestations.
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Affiliation(s)
- Tianbo Zhang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China
| | - Xialin Zhang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China
| | - Ningning Zhang
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Junrong Yan
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China
| | - Lina Wang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China
| | - Weihong Yan
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China
| | - Zhuanzhuan Yu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China
| | - Yonghong Zhang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
| | - Yanlong Duan
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
| | - Ruijuan Zhang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China
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Manisha R, Phadke SR. Long-Term Outcomes of Disease Modifying Therapies in Gaucher Disease. Indian J Pediatr 2024:10.1007/s12098-023-04986-y. [PMID: 38315376 DOI: 10.1007/s12098-023-04986-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/07/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVES To study clinical response to treatment with enzyme replacement therapy (ERT) and substrate reduction therapy (SRT) in a cohort of Gaucher disease. METHODS Retrospective data of 8 patients of Gaucher disease was compiled. The treatment included all three currently available enzyme replacement therapies as well as substrate reduction therapy with Eliglustat. The relevant blood investigations were done in follow-up visits. The assessment of the effects of long-term treatment over varying periods up to 13 y was done with various issues related to the course of therapy documented. RESULTS Improvement in hematological parameters was seen in all patients. Reduction of spleen size occurred in 7 of 8 patients (87.5%). One patient had 2 successful pregnancies while on therapy. A distinct patient with type 3 Gaucher disease developed complication in the form of Gaucheroma within the spleen. CONCLUSIONS Awareness about the disease and the efficacy of the therapies amongst pediatricians will help in early diagnosis and better outcomes. The available therapies have changed the outcome of the patients and improved the quality of life in patients with Gaucher disease. The data of Indian patients is important at this juncture when under Rare Disease Policy, government funding has become available for ERT for Gaucher disease patients in India.
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Affiliation(s)
- Rani Manisha
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - Shubha R Phadke
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India.
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Saliba T, Simoni P, Empain A, De Leucio A. Gaucheroma of Mesenteric Lymph Nodes and Their Ultrasound Appearance: A Case Report. J Belg Soc Radiol 2023; 107:40. [PMID: 37274598 PMCID: PMC10237248 DOI: 10.5334/jbsr.3184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023] Open
Abstract
Gaucher disease represents the largest lysosomal storage disease group worldwide. Possible complications include the development of Gaucheromas, pseudotumors resulting from an accumulation of Gaucher cells. Gaucheromas can affect the liver, spleen, bones, and lymph nodes. Descriptions of the appearance of lymph node gaucheromas exist for computed tomography (CT) and magnetic resonance imaging (MRI) but not, to our knowledge, of their ultrasound characteristics. We present the case of a four-year-old boy with Gaucher disease with lymph node Gaucheromas, discovered during a routine follow-up, and present their ultrasound characteristics. We describe characteristic ultrasound findings of non-B-cell lymphomas and Gaucheroma lymph nodes in comparison. Teaching point: Lymph node Gaucheromas have a characteristic ultrasound appearance and should be searched for in Gaucher's patients.
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Affiliation(s)
| | - Paolo Simoni
- Hopital Universitaire Des Enfants Reine Fabiola, BE
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Chis BA, Chis AF, Dumitrascu DL. Gaucher disease - bone involvement. Med Pharm Rep 2021; 94:S61-S63. [PMID: 34527914 DOI: 10.15386/mpr-2233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Gaucher disease (GD) is a rare genetic disease caused by the enzymatic deficiency of beta-glucocerebrosidase. This will lead to the accumulation of sphingolipids in various organs, such as liver, spleen, bone marrow. Bone involvement is frequent in Gaucher patients, leading to bone pain, necrosis and even fractures or growth deficiency in children, with painful surgeries and progressively decreasing quality of life. The early treatment initiation in symptomatic patients is very important in lowering bone complications frequency and improve general status. We present the case of a young patient whose first manifestation of GD was a bone cystic lesion and the clinical evolution until treatment.
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Affiliation(s)
- Bogdan Augustin Chis
- 2 Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ana Florica Chis
- Department of Pneumology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dan Lucian Dumitrascu
- 2 Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Ramaswami U, Mengel E, Berrah A, AlSayed M, Broomfield A, Donald A, Seif El Dein HM, Freisens S, Hwu WL, Peterschmitt MJ, Yoo HW, Abdelwahab M. Throwing a spotlight on under-recognized manifestations of Gaucher disease: Pulmonary involvement, lymphadenopathy and Gaucheroma. Mol Genet Metab 2021; 133:335-344. [PMID: 34229967 DOI: 10.1016/j.ymgme.2021.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/14/2021] [Accepted: 06/22/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Gaucher disease (GD) is a rare lysosomal storage disorder classically subdivided into type 1 (non-neuronopathic) GD, and types 2 and 3 (neuronopathic) GD. It is typically characterized by clinical manifestations including anemia, thrombocytopenia, hepatosplenomegaly, bone lesions, and (in more severe forms) neurological impairment. However, less-commonly reported and often under-recognized manifestations exist, which potentially have a significant impact on patient outcomes. Greater efforts are needed to understand, recognize, and manage these manifestations. OBJECTIVES This review provides a synthesis of published information about three under-recognized GD manifestations (pulmonary involvement, lymphadenopathy, and Gaucheroma) and recommends diagnostic, management, and treatment strategies based on the available literature and author experience. The authors aim to raise awareness about these serious, progressive, and sometimes life-threatening conditions, which are often diagnosed late in life. CONCLUSIONS Little is known about the incidence, pathophysiology, prognostic factors, and optimal management of pulmonary involvement, lymphadenopathy, and Gaucheroma in patients with GD. Enzyme replacement therapy (ERT) has shown limited efficacy for the prevention and treatment of these manifestations. More research is needed to evaluate the potential effect of substrate reduction therapy (SRT) with glucosylceramide synthase (GCS) inhibitors, and to develop additional approaches to treat these GD manifestations. Improvements in data collection registries and international data-sharing are required to better understand the impact of these manifestations on GD patients, help develop effective management strategies, and, ultimately, improve patient outcomes.
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Affiliation(s)
| | | | | | - Moeenaldeen AlSayed
- Alfaisal University and King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Alex Broomfield
- Willink Biochemical Genetics Unit, Manchester Center for Genomic Medicine, Manchester Foundation NHS Trust, UK
| | - Aimee Donald
- Willink Unit, Saint Mary's Hospital, Manchester, UK
| | | | | | | | | | - Han-Wook Yoo
- Asan Medical Center Children's Hospital, Seoul, South Korea; University of Ulsan College of Medicine, Seoul, South Korea
| | - Magy Abdelwahab
- Cairo University Pediatric Hospital, Cairo, Egypt; Social and Preventive Medicine Center, Kasr Elainy Hospital, Cairo, Egypt.
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Mahajan N, Warren M, Yano S. Reduction of large soft-tissue Gaucheromas with substrate reduction therapy. J Inherit Metab Dis 2020; 43:375-376. [PMID: 31705761 DOI: 10.1002/jimd.12188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 11/07/2022]
Abstract
Soft-tissue masses are rarely seen in Gaucher disease. We previously reported a case of a 30-year-old patient with Gaucher disease type 3, receiving β-glucocerebrosidase enzyme replacement therapy (ERT), who presented with slowly enlarging masses infiltrated with Gaucher cells along her back. Substrate reduction therapy introduced in addition to ERT, resulted in significant reduction of the large masses.
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Affiliation(s)
- Neha Mahajan
- Department of Pediatrics, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Mikako Warren
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
| | - Shoji Yano
- Genetics Division, Department of Pediatrics, LAC+USC Medical Center, University of Southern California, Los Angeles, California
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Tseng SY, Niu DM, Chu TH, Yeh YC, Huang MH, Yang TF, Liao HC, Chiang CC, Ho HC, Soong WJ, Yang CF. Very rare condition of multiple Gaucheroma: A case report and review of the literature. Mol Genet Metab Rep 2019; 20:100489. [PMID: 31341788 PMCID: PMC6629585 DOI: 10.1016/j.ymgmr.2019.100489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/23/2019] [Indexed: 11/25/2022] Open
Abstract
Background This study presented a 3 years old boy with Gaucher disease (GD) who was treated with enzyme replacement therapy(ERT) for 19 months and developed multiple Gaucheroma. The literature was reviewed. Methods The medical chart and literature were reviewed. A boy presented at the age of 15 months with anemia, thrombocytopenia, and hepatosplenomegaly. Enzyme assay and gene mutations confirmed GD. ERT was administered. When the boy was 3 years old, multiple masses were discovered from abdominal MRI and biopsy revealed Gaucheroma. We reviewed 20 GD patients with Gaucheroma and Gaucher cell infiltrated lymphadenopathies. Conclusion Gaucheroma is a rare condition in regularly treated GD patients. This patient showed poor response to doubled ERT doses. The imaging studies are necessary for Gaucher patients to detect Gaucheroma and determine their malignancy. Regular checkups are recommended in all GD patients even with ERT treatment, due to the possibility of having a deteriorating change, like Gaucheroma.
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Affiliation(s)
- Szu-Yin Tseng
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan, ROC.,Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan, ROC.,Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Tzu-Hung Chu
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan, ROC.,Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Chen Yeh
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taiwan, ROC
| | - Man-Hsu Huang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taiwan, ROC
| | - Tsui-Feng Yang
- Physical Medicine and Rehabilitation Department, Taipei Veterans, General Hospital, Taiwan, ROC
| | - Hsuan-Chieh Liao
- The Chinese Foundation of Health Neonatal Screening Center, Taiwan, ROC.,Institute of Clinical Medicine, National Yang-Ming University, Taiwan, ROC
| | - Chuan-Chi Chiang
- The Chinese Foundation of Health Neonatal Screening Center, Taiwan, ROC
| | | | - Wen-Jue Soong
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan, ROC
| | - Chia-Feng Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan, ROC.,Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taiwan, ROC
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Tseng SY, Niu DM, Chu TH, Yeh YC, Huang MH, Yang TF, Liao HC, Chiang CC, Ho HC, Soong WJ, Yang CF. Very rare condition of multiple Gaucheroma: A case report and review of the literature. Mol Genet Metab Rep 2019; 20:100473. [PMID: 31193028 PMCID: PMC6514358 DOI: 10.1016/j.ymgmr.2019.100473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/19/2019] [Accepted: 04/19/2019] [Indexed: 11/25/2022] Open
Abstract
Background This study presented a 3 years old boy with Gaucher disease (GD) who was treated with enzyme replacement therapy (ERT) for 19 months and then developed multiple Gaucheroma. Review of literature was performed simultaneously. Methods The medical chart and literature were reviewed. A boy presented at the age of 15 months with anemia, thrombocytopenia, and hepatosplenomegaly. GD was confirmed by enzyme assay and gene mutations. ERT was administered right after the diagnosis. When the boy was 3 years old, multiple masses were discovered during a regular checkup abdominal MRI and biopsy revealed Gaucheroma. We also reviewed 20 GD patients with Gaucheroma and Gaucher cell infiltrated lymphadenopathies. Conclusion Gaucheroma is a rare condition of regularly treated GD patients. This patient even showed poor response to doubled ERT doses. The imaging studies are necessary for Gaucher patients to detect Gaucheroma and determine their malignancy. Regular checkups are recommended in all GD patients even with regular treatment, due to the possibility of having deteriorating change, like Gaucheroma.
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Affiliation(s)
- Szu-Yin Tseng
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan.,Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan.,Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzu-Hung Chu
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan.,Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Chen Yeh
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taiwan
| | - Man-Hsu Huang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taiwan
| | - Tsui-Feng Yang
- Physical Medicine and Rehabilitation Department, Taipei Veterans General Hospital, Taiwan
| | - Hsuan-Chieh Liao
- The Chinese Foundation of Health Neonatal Screening Center, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taiwan
| | - Chuan-Chi Chiang
- The Chinese Foundation of Health Neonatal Screening Center, Taiwan
| | | | - Wen-Jue Soong
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan
| | - Chia-Feng Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan.,Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taiwan
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