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Severe Neonatal Manifestations of Infantile Liver Failure Syndrome Type 1 Caused by Cytosolic Leucine-tRNA Synthetase Deficiency

  • Christina Peroutka
  • Jacqueline Salas
  • Jacquelyn Britton
  • Juliet Bishop
  • Lisa Kratz
  • Maureen M. Gilmore
  • Jill A. Fahrner
  • W. Christopher GoldenEmail author
  • Tao WangEmail author
Research Report
Part of the JIMD Reports book series (JIMD, volume 45)

Abstract

Background: Deleterious mutations in cytosolic leucine-tRNA synthetase (LARS) cause infantile liver failure syndrome, type 1 (ILFS1), a recently recognized, rare autosomal recessive disorder (OMIM151350). Only six families with ILFS1 have been reported in the literature. Patients with ILFS1 are typically diagnosed between 5 and 24 months of age with failure to thrive, developmental delays, encephalopathy, microcytic anemia, and chronic liver dysfunction with recurrent exacerbations following childhood illnesses. Neonatal manifestations of this disorder have not been well documented.

Case Report: We report a premature female newborn with intrauterine growth restriction, failure to thrive, congenital anemia, anasarca, and fulminant liver failure leading to lethal multiple organ failure. Liver failure in this infant was characterized by a disproportionate impairment of liver synthetic function, including severe coagulopathy and hypoalbuminemia without significant defects in liver detoxification or evidence of hepatocellular injury during early phase of the disease. Whole-exome sequencing of child-parent trio identified two inherited missense mutations in LARS in this patient. One, c.1292T>A; p.Val431Asp, has been reported in patients with ILFS1, while the other, c.725C>T; p.Pro242Leu, is novel. Both mutations involve amino acid residues in the highly conserved editing domain of LARS, are predicted to be functionally deleterious, and presumably contribute to the clinical manifestations in this patient.

Conclusion: This is the first case documenting neonatal manifestation of ILFS1, highlighting early, severe, and disproportionate defects in liver synthetic function. Timely diagnosis of ILFS1 is crucial to guide critical clinical management and improve outcomes of this rare and potentially life-threatening disorder.

Keywords

Fulminant liver failure Infantile liver failure syndrome 1 Leucine-tRNA synthetase Mutations Neonate 

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Copyright information

© Society for the Study of Inborn Errors of Metabolism (SSIEM) 2018

Authors and Affiliations

  • Christina Peroutka
    • 1
    • 2
  • Jacqueline Salas
    • 1
  • Jacquelyn Britton
    • 2
  • Juliet Bishop
    • 2
  • Lisa Kratz
    • 2
    • 3
  • Maureen M. Gilmore
    • 1
  • Jill A. Fahrner
    • 1
    • 2
  • W. Christopher Golden
    • 1
    Email author
  • Tao Wang
    • 1
    • 2
    Email author
  1. 1.Department of PediatricsJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Institute of Genetic Medicine, Johns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Kennedy Krieger InstituteBaltimoreUSA

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