Rxe9;sumxe9;
Nous rapportons le cas d’un enfant ayant pr
xe9;sent
xe9;
xe0; l’
xe2;ge de 3 ans un coma hypoglyc
xe9;mique hypoc
xe9;tosique au d
xe9;cours d’u
ne primo-
infection
xe0; virus d’Epstein-Barr (EBV). La pr
xe9;sence de la mutation G1528C
xe0; l’
xe9;tat homozygote a permis d’affirmer le diagnostic de d
xe9;ficit en 3-hydroxyacyl-CoA d
xe9;shydrog
xe9;nase des acides gras
xe0; cha
xee;
ne longue (LCHAD), de mettre en place un r
xe9;gime adapt
xe9; avec pr
xe9;vention du jeû
ne et suppl
xe9;mentation en L-carniti
ne. L’
xe9;volution
xe0; 2 ans du diagnostic initial s’est faite vers l’apparition d’u
ne r
xe9;tinopathie et l’aggravation d’u
ne fatigabilit
xe9;
xe0; l’effort. Le diagnostic de d
xe9;ficit en LCHAD se fait souvent avant l’
xe2;ge de 2 ans. L’
xe2;ge tardif de r
xe9;v
xe9;lation chez notre patient
xe9;tait li
xe9;
xe0; un r
xe9;gime spontan
xe9; d’exclusion des graisses animales (d
xe9;goût pour la viande, alimentation
xe0; base de riz blanc et de lait
xe9;cr
xe9;m
xe9;) et au maintien de t
xe9;t
xe9;es noctur
nes jusqu’
xe0; 3 ans. La d
xe9;couverte, a posteriori, d’u
ne cholestase gravidique en fin de grossesse nous a incit
xe9;s
xe0; mettre en place un d
xe9;pistage n
xe9;onatal syst
xe9;matique et u
ne surveillance clinique.
Summary
Observation
We report on the case of a 3-year-old child from La Rxe9;union island, who presented with hypoglycemic hypoketotic coma secondary to a primary Epstein-Barr virus (EBV) infection. The discovery of the G1528C homozygote mutation provided the diagnosis of long-chain-3-hydroxyacyl-CoA-dehydrogenase (LCHAD); an adapted dietary plan with prevention of fasting and L-carnitine supplementation was initiated. After 2 years, a pigmentary retinopathy appeared and muscle weakness increased.
Comments
Isolated LCHAD deficiency is an autosomal recessive disorder of fatty acid metabolism. Prevalence is about 1–9/100,000 and diagnosis is often made before the age of 2 years. The late age of revelation in our case is related to a spontaneous diet without animal fats (disgust for meat, diet based on white rice and skimmed milk) and nighttime breastfeeding until the age of 3 years. In an affected fetus, heterozygous mothers are susceptible to developing a hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome or an acute fatty liver pregnancy (AFLP) syndrome during the 3rd trimester of pregnancy, which motivated us to set up a systematic neonatal screening program and a specific monitoring of these newborns.