Term Neonate Presenting with the Combined Occurrence of Mucolipidosis Type II and Leigh Syndrome

Abstract

Mucolipidosis II α/beta (MLII) is an autosomal recessive disease in which a gene mutation leads to improper targeting of lysosomal enzymes with an end result of accumulation of lysosomes in the mitochondria resulting in a dysfunctional mitochondria. 1 Leigh syndrome (LS) is a rare progressive neurodegenerative disorder associated with dysfunctional mitochondria and oxidative phosphorylation. 4 Both disease processes typically present in infancy. 3 7 Herein, we present a case of an infant diagnosed with both mucolipidosis II and Leigh syndrome. Genetic analysis in this case revealed two mutations (NDUFA12 c.178C > T p.Arg60* and GNPTAB c.732_733delAA) on the long arm of chromosome 12 as the etiology of MLII and LS in this neonate, respectively. We are unaware of any previously published cases of the presence of these two diseases occurring in the same patient. The complex clinical presentation of this case led to a delay in the diagnosis, and we believe that the clinical phenotypes of these two conditions were likely worsened. The genetic alterations presented in this case occurred as a result of mutations on chromosome 12. We suggest further investigation into the potential overlap in the pathophysiology, specifically the inheritance pattern, linkage disequilibrium, mitochondrial-lysosomal interaction, or crosstalk contributing to both diseases.

Keywords: I cell disease; Leigh syndrome; mucolipidosis II.

Fig. 1

Chest X-ray showing hypoinflated lungs, dysplastic bones throughout the thorax, and visualized upper extremities.

Fig. 2

Long bones X-rays showing osteopenia with significant shortening of the long bones, thickening of the diaphyses, and irregular metaphyses.

Fig. 3

Pedigree depicting the biological relationship and inheritance pattern of the genetic mutation c.178C > T of the NDUFA12 gene resulting in Leigh syndrome and the c.732_733delAA mutation of the GNPTAB gene, causing mucolipidosis II α/beta. The patient in the presented case is indicated by an arrow.

Fig. 4

Diagram of chromosome 12. The first arrow at 12q22 marks the c.178C > T mutation of the NDUFA12 gene causing Leigh syndrome. The second arrow at 12q23.2 marks the c.732_733delAA mutation of the GNPTAB gene, causing mucolipidosis II α/beta.