Department of Neurology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India.
Department of Neuropathology, NIMHANS, Bengaluru, Karnataka, India.
Ann Afr Med. 2022 Jul-Sep;21(3):296-298. doi: 10.4103/aam.aam_260_21.
Familial amyloid polyneuropathy (PN), also known as amyloid transthyretin (TTR)-PN is an autosomal dominant adult-onset fatal disease, if not treated. It occurs due to mutations in (TTR) gene which leads to a faulty TTR protein which folds up to form amyloid and gets deposited mainly on nerves and causes length-dependent PN and autonomic dysfunction. We report a case of a 45-year-old female who presented with symptoms of painful peripheral neuropathy for 5 months, a history of deafness for 5 years, and cardiac pacemaker implantation 2 years ago for complete heart block. She denied any symptoms of autonomic dysfunction. Her brother with similar symptoms died of cardiac arrest at the age of 50 years. Clinical examination was suggestive of symmetrical sensorimotor PN. The nerve conduction study was suggestive of axonal sensorimotor PN. Abdominal fat biopsy was negative for amyloid. Sural nerve biopsy was suggestive of amyloid neuropathy. Genetic analysis showed c. 165G > T mutation encoding amino acid p. Lys55Asn on exon-4 of TTR gene. This mutation has not been reported from India.
家族性淀粉样多发性神经病(PN),也称为淀粉样转甲状腺素(TTR)-PN,是一种常染色体显性遗传的成年发病致命性疾病,如果不治疗的话。它是由于(TTR)基因突变引起的,导致 TTR 蛋白错误折叠形成淀粉样物质,并主要沉积在神经上,导致长度依赖性多发性神经病和自主神经功能障碍。我们报告了一例 45 岁女性患者,其主要表现为 5 个月的周围性神经痛症状,5 年前开始出现耳聋,2 年前因完全性心脏阻滞植入心脏起搏器。她否认有任何自主神经功能障碍的症状。她有类似症状的哥哥在 50 岁时因心脏骤停去世。临床检查提示对称性感觉运动多发性神经病。神经传导研究提示轴索性感觉运动多发性神经病。腹部脂肪活检未发现淀粉样物质。腓肠神经活检提示淀粉样神经病。基因分析显示 TTR 基因外显子 4 上的 c.165G>T 突变,导致编码氨基酸 p. Lys55Asn。这种突变尚未在印度报道过。