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勿漏诊早发性溶血尿毒综合征的罕见且可治疗病因:钴胺素 C 缺乏症。

Do not Miss Rare and Treatable Cause of Early-Onset Hemolytic Uremic Syndrome: Cobalamin C Deficiency.

机构信息

Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University, Ankara, Turkey,

Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University, Ankara, Turkey.

出版信息

Nephron. 2019;142(3):258-263. doi: 10.1159/000497822. Epub 2019 May 28.


DOI:10.1159/000497822
PMID:31137025
Abstract

The most common disorder of vitamin B12 metabolism is methylmalonic aciduria and homocystinuria type cobalamin C (cblC), which accounts for most of the cases is referred to as cblC deficiency. Cobalamin deficiency is one of the causes of early-onset hemolytic uremic syndrome (HUS). Here, we present the cases of 2 infants with cobalamin deficiency who presented with early-onset HUS. The first patient was a 5-month-old female who was admitted to the hospital with seizure, pallor, and yellow-colored diarrheal stools. Initial laboratory examination showed direct Coombs test-negative hemolytic anemia. Later, she developed acute kidney injury and thrombocytopenia. Bone marrow aspiration showed megaloblastic features, and urinary examination showed elevated levels of methylmalonic acid (MMA), -methyl citrate, and 3-hydroxypropionic acid. Methionine-restricted diet, parenteral hydroxocobalamine, folinic acid, carnitine, and betaine were initiated. Hemolytic activity was -controlled with this treatment. Genetic screening showed homozygous mutation on the MMACHCgene (p.R161*[c.481C>T]). The second patient was a 3-month-old male infant who was admitted to the hospital with malaise and diarrhea. Laboratory examination showed direct Coombs test-negative hemolytic anemia with leukopenia. Later he developed acute kidney injury and thrombocytopenia. Bone marrow aspiration revealed megaloblastic changes. Urine organic acid test showed increased levels of MMA. Parenteral hydroxocobalamine, folinic acid, carnitine, and betaine were initiated. He died due to respiratory failure and cardiac arrest. Direct sequencing of MMACHC identified homozygous mutation, c.271dup A. CblC deficiency is an important cause of early-onset HUS and prompt diagnosis will provide specific treatment modalities.

摘要

维生素 B12 代谢最常见的紊乱是甲基丙二酸血症和同型半胱氨酸尿症 c 型钴胺素(cblC),其中大多数病例被称为 cblC 缺乏症。钴胺素缺乏症是早发性溶血尿毒综合征(HUS)的原因之一。在这里,我们介绍了 2 例因钴胺素缺乏而出现早发性 HUS 的婴儿病例。第一个患者是一名 5 个月大的女性,因抽搐、苍白和黄色腹泻性粪便入院。最初的实验室检查显示直接抗 Coombs 试验阴性溶血性贫血。后来,她出现急性肾损伤和血小板减少症。骨髓抽吸显示巨幼细胞特征,尿液检查显示甲基丙二酸(MMA)、-甲基柠檬酸和 3-羟基丙酸水平升高。开始采用限制蛋氨酸饮食、羟钴胺素、叶酸、肉碱和甜菜碱进行治疗。用这种治疗方法控制了溶血活性。基因筛查显示 MMACHC 基因(p.R161*[c.481C>T])纯合突变。第二个患者是一名 3 个月大的男性婴儿,因不适和腹泻入院。实验室检查显示直接抗 Coombs 试验阴性溶血性贫血伴白细胞减少症。后来他出现急性肾损伤和血小板减少症。骨髓抽吸显示巨幼细胞变化。尿液有机酸测试显示 MMA 水平升高。开始使用羟钴胺素、叶酸、肉碱和甜菜碱进行治疗。他因呼吸衰竭和心脏骤停而死亡。MMACHC 的直接测序确定了纯合突变,c.271dup A。cblC 缺乏症是早发性 HUS 的重要原因,及时诊断将提供特定的治疗方法。

相似文献

[1]
Do not Miss Rare and Treatable Cause of Early-Onset Hemolytic Uremic Syndrome: Cobalamin C Deficiency.

Nephron. 2019-5-28

[2]
The roles of homocysteinemia and methylmalonic acidemia in kidney injury in atypical hemolytic uremic syndrome caused by cobalamin C deficiency.

Pediatr Nephrol. 2022-6

[3]
Clinical characteristics of hemolytic uremic syndrome secondary to cobalamin C disorder in Chinese children.

World J Pediatr. 2015-8-8

[4]
Cobalamin C disease presenting as hemolytic-uremic syndrome in the neonatal period.

J Pediatr Hematol Oncol. 2002-5

[5]
Hemolytic uremic syndrome with dual caution in an infant: cobalamin C defect and complement dysregulation successfully treated with eculizumab.

Pediatr Nephrol. 2018-3-20

[6]
Cobalamin c deficiency associated with antifactor h antibody-associated hemolytic uremic syndrome in a young adult.

BMC Nephrol. 2020-3-12

[7]
Atypical hemolytic uremic syndrome induced by CblC subtype of methylmalonic academia: A case report and literature review.

Medicine (Baltimore). 2017-10

[8]
Adult-onset eculizumab-resistant hemolytic uremic syndrome associated with cobalamin C deficiency.

Am J Kidney Dis. 2013-11-6

[9]
Hemolytic uremic syndrome (HUS) secondary to cobalamin C (cblC) disorder.

Pediatr Nephrol. 2007-12

[10]
Cobalamin C defect-hemolytic uremic syndrome caused by new mutation in MMACHC.

Pediatr Int. 2016-8

引用本文的文献

[1]
Spectrum of genetic mutations in methylmalonic aciduria among Iranian patients.

Sci Rep. 2025-5-12

[2]
Case presentation: a severe case of cobalamin c deficiency presenting with nephrotic syndrome, malignant hypertension and hemolytic anemia.

BMC Nephrol. 2024-7-8

[3]
Hemolytic Uremic Syndrome in Children.

Turk Arch Pediatr. 2021-9

[4]
Hemolytic Uremic Syndrome Due to Methylmalonic Acidemia and Homocystinuria in an Infant: A Case Report and Literature Review.

Children (Basel). 2021-2-5

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