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Review
. 2023 Aug 29;17(1):369.
doi: 10.1186/s13256-023-04116-4.

Wolman disease presenting with hemophagocytic lymphohistiocytosis syndrome and a novel LIPA gene variant: a case report and review of the literature

Kosar Asna Ashari  1   2   3   4 , Aileen Azari-Yam  1   2 , Mohammad Shahrooei  5 , Vahid Ziaee  6   7   8   9
Affiliations
Review

Wolman disease presenting with hemophagocytic lymphohistiocytosis syndrome and a novel LIPA gene variant: a case report and review of the literature

Kosar Asna Ashari et al. J Med Case Rep. .

Abstract

Background: Wolman disease is a rare disease caused by the absence of functional liposomal acid lipase due to mutations in LIPA gene. It presents with organomegaly, malabsorption, and adrenal calcifications. The presentations can resemble hemophagocytic lymphohistiocytosis, the life threatening hyperinflammatory disorder. Since the disease is very rare, clinicians might not think of it when a patient presents with hemophagocytic lymphohistiocytosis, and the opportunity to treat it properly can be lost, thus leading to demise of the child.

Case presentation: We present a 4.5-month-old Caucasian boy with fever, icterus, and hepatosplenomegaly who was treated according to presumed hemophagocytic lymphohistiocytosis disease. Wolman disease was diagnosed after the death of the child. There are some case reports in the literature presenting patients with Wolman disease primarily diagnosed as hemophagocytic lymphohistiocytosis, which we discuss in this review. The genetic analysis revealed after his demise was compatible with Wolman disease, introducing a novel mutation in LIPA gene: exon 4: NM_001127605: c. G353A (p.G118D), which converts the glycine amino acid to aspartic acid.

Conclusions: Considering the similarities in presentation of Wolman disease and hemophagocytic lymphohistiocytosis, the patient's life can be saved if special attention is paid to presenting features of a patient with suspected hemophagocytic lymphohistiocytosis, that is special attention to symptoms, findings on physical exams, laboratory values, and radiologic findings, and the proper treatment is urgently initiated. Reporting the novel mutations of Wolman disease can help geneticists interpret the results of their patients' genetic studies appropriately, leading to correct diagnosis and treatment.

Keywords: HLH; Hemophagocytic lymphohistiocytosis; LIPA gene; Wolman disease.

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Conflict of interest statement

There are no competing interests to declare.

Figures

Fig. 1
Fig. 1
Peripheral blood smear of our patient stained by Romanovski method showing a lymphocyte with cytoplasmic vacuolation
Fig. 2
Fig. 2
An electropherogram of father (top), mother (second), patient (third), and control (bottom), demonstrates a mutation (arrow) in exon 4 that results in conversion of amino acid glycine at position 118 to aspartic acid. On the top, the arrow indicates the paternally inherited c.482delA and the arrow in the second row approximates the location of the maternally inherited deletion
Fig. 3
Fig. 3
Three-dimensional illustration of the original LIPA1 molecule with wild-type glycine residue (A) and a more detailed look inside the LIPA1 molecule with wild-type (B) and the mutated residue (C). Considering the similarities in presentations of WD and HLH, the patient’s life can be saved if special attention is paid to presenting features of a patient with suspected HLH, that is symptoms, findings on physical exams, laboratory values, and radiologic findings, and if the proper treatment is urgently initiated. Reporting the novel mutations of WD can help geneticists interpret the results of their patients’ genetic studies appropriately, leading to correct diagnosis and treatment
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