Infantile-onset Pompe disease with neonatal debut: A case report and literature review

Abstract

Rationale: Infantile-onset Pompe disease, also known as glycogen storage disease type II, is a progressive and fatal disorder without treatment. Enzyme replacement therapy with recombinant human acid alpha-glucosidase (GAA) enhances survival; however, the best outcomes have been achieved with early treatment.

Patient concerns: We report a case of a newborn with infantile-onset Pompe disease diagnosed in the first days of life who did not undergo universal neonatal screening. The patient was asymptomatic, with a general physical examination revealing only a murmur. The clinical presentation was dominated by the neonatal detection of hypertrophic cardiomyopathy, without hypotonia or macroglossia.

Diagnoses: Pompe disease was confirmed in the first week of life by GAA activity in dried blood spots, and a GAA genetic study showed the homozygous mutation p.Arg854X.

Interventions: Parents initially refused replacement therapy.

Outcomes: The patient experienced recurrent episodes of ventricular fibrillation during central line placement and could not be resuscitated.

Lessons: Although Pompe disease is rare, and universal screening has not been established, neonatologists should be alerted to the diagnosis of Pompe in the presence of hypertrophic cardiomyopathy. Diagnosis is achieved in a few days with the aid of dried blood spots.

Figure 1

(A) and (B) electrocardiogram (A) at diagnosis and (B) at 3 months of age.

Figure 2

. A 2D echocardiogram with an apical 4-chamber view at diagnosis.

Figure 3

Photomicrography of the myocardium. A (H&E, 400×) and B (PAS, 400×), showing diffuse myocyte vacuolization. H&E = hematoxylin and eosin, PAS = periodic acid–schiff.