RSS-Feed abonnieren
DOI: 10.1055/s-0035-1549874
A Thiamine Responsive Megaloblastic Anemia Presented with Hypertriglyceridemia and Auto-immune Diabetes
One Sentence Summary: Thiamine therapy might be an alternative in patients presenting with diabetes and anemia.Publikationsverlauf
received 20. November 2014
first decision 15. März 2015
accepted 08. April 2015
Publikationsdatum:
15. Februar 2017 (online)
Abstract
Background: Thiamine responsive megaloblastic anemia syndrome (TRMA) is an autosomal recessive disorder characterized by non type 1 diabetes mellitus (DM), sensorineural hearing loss and megaloblastic anemia and caused by mutations in SLC19A2 gene, encoding a thiamine transporter protein.
Case: A 3-month-old male infant presented with megaloblastic anemia, DM, patent ductus arteriosus and hypertriglyceridemia. His autoimmune markers for DM were positive but with the additional finding of sensorineural deafness he was diagnosed with TRMA and thiamine therapy was started. His anemia was improved and insulin needs decreased and his genetic studies revealed a homozygous frameshift mutation, c.641del within coding region of SLC19A2 gene.
Conclusion: Clinical presentation of TRMA could be highly variable and some co-existence could perplex physicians, but this diagnosis should be considered in all patients with DM and anemia and further assessment should be done.
-
References
- 1 Meire FM, Van Genderen MM, Lemmens K, Ens-Dokkum MH. Thiamine-responsive megaloblastic anaemia syndrome (TRMA) with cone-rod dystrophy. Ophthalmic Genet 2000; 21: 243-250
- 2 Lorber A, Gazit AZ, Khoury A, Schwartz Y, Mandel H. Cardiac manifestations in thiamine-responsive megaloblastic anaemia syndrome. Paediatric Cardiology 2003; 24: 476-481
- 3 Villa V, Rivellese A, Di Salle F, Iovine C, Poggi V, Capaldo B. Acute ischemic stroke in a young woman with the thiamineresponsive megaloblastic anaemia syndrome. J Clin Endocrinol Metab 2000; 85: 947-949
- 4 Lagarde WH, Underwood LE, Moats-Staats BM, Calikoglu AS. Novel mutation in the SLC19A2 gene in an African-American female with thiamine- responsive anemia syndrome. Am J Med Genetics 2004; 125A: 299-305
- 5 Porter FS, Rogers LE, Sidbury Jr JB. Thiamine responsive megaloblastic anaemia. J Pediatr 1969; 74: 494-504
- 6 Fleming JC, Tartaglini E, Steinkamp MP, Schorderet DF, Cohen N, Neufeld EJ. The gene mutated in thiamineresponsive anaemia with diabetes and deafness (TRMA) encodes a functional thiamine transporter. Nat Genet 1999; 22: 305-308
- 7 Bay A, Keskin M, Hizli S, Uygun H, Dai A, Gumruk F. Thiamine-responsive megaloblastic anemia syndrome. Int J Hematol 2010; 92: 524-526
- 8 Yuan G, Al-Shali KZ, Hegele RA. Hypertriglyceridemia: its etiology, effects and treatment. CMAJ 2007; 176: 1113-1120
- 9 Johansen CT, Hegele RA. Genetic bases of hypertriglyceridemic phenotypes. Curr Opin Lipidol 2011; 22: 247-253
- 10 Irwin JJ, Kirchner JT. Anemia in children. Am Fam Physician 2001; 64: 1379-1386
- 11 Janus J, Moerschel SK. Evaluation of anemia in children. Am Fam Physician 2010; 81: 1462-1471
- 12 Hattersley AT, Bruining J, Shield J, Njolstad P, Donaghue KC. The diagnosis and management of monogenic diabetes in children and adolescents. Pediatric Diabetes 2009; 10: 33-42
- 13 Kucukemre Aydın B, Bundak R, Baş F, Maraş H, Saka N, Gunoz H et al. Permanent neonatal diabetes mellitus: Same mutation, different glycemic control with sulfonylurea therapy on long-term follow-up. J Clin Res Pediatr Endocrinol 2012; 4: 105-108
- 14 Akın L, Kurtoğlu S, Kendirci M, Akın MA, Karakükçü M. Does early treatment prevent deafness in thiamine-responsive megaloblastic anaemia syndrome?. J Clin Res Pediatr Endocrinol 2011; 3: 36-39
- 15 Thornalley PJ, Babaei-Jadidi R, Al Ali H, Rabbani N, Antonysunil A, Larkin J et al. High prevalence of low plasma thiamine concentration in diabetes linked to a marker of vascular disease. Diabetologia 2007; 50: 2164-2170
- 16 Rabbani N, Thornalley PJ. Emerging role of thiamine therapy for prevention and treatment of early-stage diabetic nephropathy. Diabetes Obes Metab 2011; 13: 577-583
- 17 Ozdemir MA, Akcakus M, Kurtoglu S, Gunes T, Torun YA. TRMA syndrome (thiamine-responsive megaloblastic anaemia): a case report and review of the literature. Pediatr Diabetes 2002; 3: 205-209
- 18 Ricketts CJ, Minton JA, Samuel J, Ariyawansa I, Wales JK, Lo IF. Thiamine-responsive megaloblastic anaemia syndrome: long-term follow-up and mutation analysis of seven families. Acta Paediatr 2006; 95: 99-104
- 19 Crouzet-Ozenda Luci L, De Smet S, Monpoux F, Ferrero-Vacher C, Giuliano F, Sirvent N. Galactosemia associated with Rogers syndrome in a 10-month-old infant. Arch Pediatr 2011; 18: 54-57
- 20 Chahil TJ, Ginsberg HN. Diabetic dyslipidemia. Endocrinol Metab Clin North Am 2006; 35: 491-510