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Hepatosplenomegaly, pneumopathy, bone changes and fronto-temporal dementia: Niemann–Pick type B and SQSTM1-associated Paget’s disease in the same individual
Ist Teil von
Journal of bone and mineral metabolism, 2019-03, Vol.37 (2), p.378-383
Ort / Verlag
Tokyo: Springer Japan
Erscheinungsjahr
2019
Quelle
Alma/SFX Local Collection
Beschreibungen/Notizen
Data from exome sequencing show that a proportion of individuals in whom a genetic disorder is suspected turn out to have not one, but two to four distinct ones. This may require an evolution in our diagnostic attitude towards individuals with complex disorders. We report a patient with splenomegaly, pneumopathy, bone changes and fronto-temporal dementia (FTD). “Sea-blue histiocytes” in his bone marrow pointed to a lysosomal storage disease. Homozygosity for a pathogenic mutation in the
SMPD1
gene confirmed Niemann–Pick disease type B (NPD-B). Mild cognitive impairment and abnormal brain FDG PET were consistent with FTD. We initially tried to fit the skeletal and neurologic phenotype into the NPD-B diagnosis. However, additional studies revealed a pathogenic mutation in the
SQSTM1
gene. Thus, our patient had two distinct diseases; NPD-B, and Paget’s disease of bone with FTD. The subsequent finding of a mutation in
SQSTM1
gene ended our struggle to explain the combination of findings by a singular “unifying” diagnosis and allowed us to make specific therapeutic decisions.
SQSTM1
mutations have been reported in association with FTD, possibly because of defective autophagy. Bisphosphonates may be beneficial for PDB, but since they are known to inhibit acid sphingomyelinase activity, we refrained from using them in this patient. While the principle of looking for unifying diagnosis remains valid, physicians should consider the possibility of co-existing multiple diagnoses when clinical features are difficult to explain by a single one. Accurate diagnostic work-up can guide genetic counseling but also lead to better medical management.