A New Case of Schindler Disease

Abstract

Lysosomal storage disorders (LSDs) are a group of genetic disorders caused by mutations in genes encoding enzymes involved in lysosomal function. Schindler disease is an autosomal recessive, inherited LSD caused by defective or non-existent activity of the enzyme α-N-acetylgalactosaminidase (α-NAGA). To date, three main phenotypes of Schindler disease have been described. We report the case of a 68-year-old man presenting with axonal and demyelinating polyneuropathy, sensorineural hearing loss, chronic lymphoedema, angiokeratoma corporis diffusum and bilateral carpal tunnel syndrome. Genetic testing (PCR) for α-galactosidase revealed the c.577G>T (p.Glu193*) mutation in the NAGA gene, confirming Schindler disease, which is clinically compatible with Kanzaki disease and Schindler disease type II.

Learning points: Schindler disease is a very rare lysosomal storage disorder.To our knowledge, fewer than 20 cases have been described to date.Consequently, each new case should be reported to enhance understanding of the wide range of presentations.

Keywords: Angiokeratoma corporis diffusum; Kanzaki disease; alpha-N-acetylgalactosaminidase; peripheral neuropathy.

Figure 1

Symmetrical massive lymphoedema, with thickened nodular skin and brownish pigmentation. (a) On the abdomen, multiple angiokeratomas (b) can be seen, which under dermatoscopy show red lacunae (c)

Figure 2

Angiokeratomas with superficial (upper dermis) vascular ectasia (a) and overlying epidermal hyperplasia (acanthosis and/or hyperkeratosis) (b)