Metachromatic leukodystrophy is a rare disorder of myelin metabolism. This degenerative disorder results from the accumulation of cerebroside sulfatide within the myelin sheath of central and peripheral nervous system, due to deficiency of aryl sulfatase A enzyme. We report a 5-year-old male child, who presented with regression of milestones, recurrent seizures and spasticity from second year of life. Initially neurodegenerative disorder was considered and the case was investigated with neuroimaging and enzyme levels. Computed tomography (CT) of the brain showed hypodensities in the corpus callosum and bilateral periventricular and deep cerebral white matter suggestive of neurodegenerative disorder. Subsequently, magnetic resonance imaging (MRI) of the brain was done, which showed symmetrical hyperintensities in the periventricular white matter with classical sparing of subcortical "U" fibers. The β-galactosidase enzyme activity was normal; however, the activity of aryl sulfatase A enzyme was undetectable, confirming the diagnosis of late infantile variant of metachromatic leukodystrophy.
BACKGROUND:Congenital rubella syndrome (CRS) is the second leading cause of nontraumatic childhood cataracts in India. While nuclear cataract is the most common abnormality reported in CRS, congenital glaucoma is a rarer manifestation. CASE REPORT: A 34weeks low birth weight, male neonate was born by vaginal delivery with normal APGARS. The neonate had sparse hypo pigmented hair over the scalp, along with hypopigmented eye brows and eye lashes. There were erythematous lesions over palms, soles and groin region. Eye examination revealed bilateral nuclear cataracts along with buphthalmos. The neonate also had clinical manifestations of PDA, which was confirmed by 2-D Echo. Systemic involvement was seen as hepatosplenomegaly and bilateral cryptorchidism. Hence CRS was suspected and further evaluation was done. There was thrombocytopenia, mild unconjugated hyperbilirubinemia with elevated transaminases. Neurosonogram was normal and there were no intra cranial calcifications. TORCH profile in both mother and baby showed elevated rubella IgM levels confirming CRS. The neonate received supportive and symptomatic treatment. DISCUSSION: congenital nuclear cataracts are reported in 60-80% of CRS, while buphthalmos is rarely seen, more so in neonatal period. PDA occurs in 50% of CRS and two-thirds have hepatosplenomegaly. Rubelliform rash is infrequent in neonates with CRS. CONCLUSION: We report a preterm low birth weight, male neonate with congenital rubella syndrome and its rare manifestations.
International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor.
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