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Innocent Adult-onset type II citrullinemia complicating pregnancy

Year 2024, Volume: 41 Issue: 3, 676 - 678, 30.09.2024

Abstract

Type II citrullinemia (CTLN2) is a rare autosomal recessive disorder characterized by hyperammonaemic encephalopathy, resulting from mutations in the SLC25A13 gene. It has age-related clinical manifestations, including neonatal intrahepatic cholestasis and adult-onset presentations. This case report presented a pregnant woman diagnosed with innocent CTLN2. A 22-year-old pregnant woman was diagnosed with CTLN2 after presenting with mental fog, agitation, and elevated ammonia levels. Her pregnancy was terminated, and she subsequently had three more successful pregnancies, during which she was treated with sodium benzoate, L-Arginine, and a protein-poor diet. Her symptoms and liver function tests improved with treatment. This was the first case report of a pregnant woman with CTLN2. Timely diagnosis and appropriate management strategies are crucial for both maternal and fetal health in cases of liver disease during pregnancy. CTLN2 should be considered in the differential diagnosis of coma in pregnancy, particularly when elevated liver enzymes and hyperammonaemia are present.

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References

  • Saheki T, Kobayashi K, Iijima M, et al. Pathogenesis and pathophysiology of citrin (a mitochondrial aspartate glutamate carrier) deficiency. Metab Brain Dis. 2002;17(4):335-346.
  • Fiermonte G, Soon D, Chaudhuri A, et al. An adult with type 2 citrullinemia presenting in Europe. N Engl J Med. 2008;358(13):1408-1409.
  • Takenaka K, Yasuda I, Araki H, et al. Type II citrullinemia in an elderly patient treated with living related partial liver transplantation. Intern Med. 2000;39(7):553-558.
  • Saheki T, Inoue K, Tushima A, Mutoh K, Kobayashi K. Citrin deficiency and current treatment concepts. Mol Genet Metab. 2010;100 Suppl 1:S59-64.
  • Slack AJ, Auzinger G, Willars C, et al. Ammonia clearance with haemofiltration in adults with liver disease. Liver Int. 2014;34(1):42-48.
  • Komatsu M, Kimura T, Yazaki M, et al. Steatogenesis in adult-onset type II citrullinemia is associated with down-regulation of PPARalpha. Biochim Biophys Acta. 2015;1852(3):473-481.
  • Bosoi CR, Rose CF. Identifying the direct effects of ammonia on the brain. Metab Brain Dis. 2009;24(1):95-102.
  • Takagi H, Hagiwara S, Hashizume H, et al. Adult onset type II citrullinemia as a cause of non-alcoholic steatohepatitis. J Hepatol. 2006;44(1):236-239.
  • Saheki T, Kobayashi K. Mitochondrial aspartate glutamate carrier (citrin) deficiency as the cause of adult-onset type II citrullinemia (CTLN2) and idiopathic neonatal hepatitis (NICCD). J Hum Genet. 2002;47(7):333-341.
  • Ikeda S, Yazaki M, Takei Y, et al. Type II (adult onset) citrullinaemia: clinical pictures and the therapeutic effect of liver transplantation. J Neurol Neurosurg Psychiatry. 2001;71(5):663-670.
  • Suzuki H, Kawamura Y, Kinowaki K, et al. The Lack of Hepatocyte Steatosis in Adult-onset Type II Citrullinemia Patients as Assessed by 7-year Interval Paired Biopsies. Intern Med. 2019;58(13):1891-1895.
Year 2024, Volume: 41 Issue: 3, 676 - 678, 30.09.2024

Abstract

References

  • Saheki T, Kobayashi K, Iijima M, et al. Pathogenesis and pathophysiology of citrin (a mitochondrial aspartate glutamate carrier) deficiency. Metab Brain Dis. 2002;17(4):335-346.
  • Fiermonte G, Soon D, Chaudhuri A, et al. An adult with type 2 citrullinemia presenting in Europe. N Engl J Med. 2008;358(13):1408-1409.
  • Takenaka K, Yasuda I, Araki H, et al. Type II citrullinemia in an elderly patient treated with living related partial liver transplantation. Intern Med. 2000;39(7):553-558.
  • Saheki T, Inoue K, Tushima A, Mutoh K, Kobayashi K. Citrin deficiency and current treatment concepts. Mol Genet Metab. 2010;100 Suppl 1:S59-64.
  • Slack AJ, Auzinger G, Willars C, et al. Ammonia clearance with haemofiltration in adults with liver disease. Liver Int. 2014;34(1):42-48.
  • Komatsu M, Kimura T, Yazaki M, et al. Steatogenesis in adult-onset type II citrullinemia is associated with down-regulation of PPARalpha. Biochim Biophys Acta. 2015;1852(3):473-481.
  • Bosoi CR, Rose CF. Identifying the direct effects of ammonia on the brain. Metab Brain Dis. 2009;24(1):95-102.
  • Takagi H, Hagiwara S, Hashizume H, et al. Adult onset type II citrullinemia as a cause of non-alcoholic steatohepatitis. J Hepatol. 2006;44(1):236-239.
  • Saheki T, Kobayashi K. Mitochondrial aspartate glutamate carrier (citrin) deficiency as the cause of adult-onset type II citrullinemia (CTLN2) and idiopathic neonatal hepatitis (NICCD). J Hum Genet. 2002;47(7):333-341.
  • Ikeda S, Yazaki M, Takei Y, et al. Type II (adult onset) citrullinaemia: clinical pictures and the therapeutic effect of liver transplantation. J Neurol Neurosurg Psychiatry. 2001;71(5):663-670.
  • Suzuki H, Kawamura Y, Kinowaki K, et al. The Lack of Hepatocyte Steatosis in Adult-onset Type II Citrullinemia Patients as Assessed by 7-year Interval Paired Biopsies. Intern Med. 2019;58(13):1891-1895.
There are 11 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Case Report
Authors

Mehmet Albayrak 0000-0002-2371-6437

Süleyman Güven 0000-0003-4832-4525

Emine Seda Güvendağ Güven 0000-0002-3056-6828

Publication Date September 30, 2024
Submission Date March 29, 2024
Acceptance Date May 31, 2024
Published in Issue Year 2024 Volume: 41 Issue: 3

Cite

APA Albayrak, M., Güven, S., & Güvendağ Güven, E. S. (2024). Innocent Adult-onset type II citrullinemia complicating pregnancy. Journal of Experimental and Clinical Medicine, 41(3), 676-678.
AMA Albayrak M, Güven S, Güvendağ Güven ES. Innocent Adult-onset type II citrullinemia complicating pregnancy. J. Exp. Clin. Med. September 2024;41(3):676-678.
Chicago Albayrak, Mehmet, Süleyman Güven, and Emine Seda Güvendağ Güven. “Innocent Adult-Onset Type II Citrullinemia Complicating Pregnancy”. Journal of Experimental and Clinical Medicine 41, no. 3 (September 2024): 676-78.
EndNote Albayrak M, Güven S, Güvendağ Güven ES (September 1, 2024) Innocent Adult-onset type II citrullinemia complicating pregnancy. Journal of Experimental and Clinical Medicine 41 3 676–678.
IEEE M. Albayrak, S. Güven, and E. S. Güvendağ Güven, “Innocent Adult-onset type II citrullinemia complicating pregnancy”, J. Exp. Clin. Med., vol. 41, no. 3, pp. 676–678, 2024.
ISNAD Albayrak, Mehmet et al. “Innocent Adult-Onset Type II Citrullinemia Complicating Pregnancy”. Journal of Experimental and Clinical Medicine 41/3 (September 2024), 676-678.
JAMA Albayrak M, Güven S, Güvendağ Güven ES. Innocent Adult-onset type II citrullinemia complicating pregnancy. J. Exp. Clin. Med. 2024;41:676–678.
MLA Albayrak, Mehmet et al. “Innocent Adult-Onset Type II Citrullinemia Complicating Pregnancy”. Journal of Experimental and Clinical Medicine, vol. 41, no. 3, 2024, pp. 676-8.
Vancouver Albayrak M, Güven S, Güvendağ Güven ES. Innocent Adult-onset type II citrullinemia complicating pregnancy. J. Exp. Clin. Med. 2024;41(3):676-8.