Innocent Adult-onset type II citrullinemia complicating pregnancy
Year 2024,
Volume: 41 Issue: 3, 676 - 678, 30.09.2024
Mehmet Albayrak
,
Süleyman Güven
,
Emine Seda Güvendağ Güven
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.
Ethical Statement
Olgu sunum olduğu için etik kurul onay belgesi alınmamıştır.
Supporting Institution
Yok.
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
Mehmet Albayrak
,
Süleyman Güven
,
Emine Seda Güvendağ Güven
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.