1. Pediatric patients with lysosomal acid lipase deficiency
- Author
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Maria M. Rojas-Rojas, Jacqueline Mugnier-Quijano, David A. Suarez-Zamora, Felipe Ordoñez-Guerrero, and Rocío del Pilar López-Panqueva
- Subjects
medicine.medical_specialty ,business.industry ,Cholesterol ,Microvesicular Steatosis ,Cathepsin D ,Enzyme replacement therapy ,Lysosomal acid lipase deficiency ,medicine.disease ,Pathology and Forensic Medicine ,Transaminase ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Endocrinology ,chemistry ,Fibrosis ,030220 oncology & carcinogenesis ,Internal medicine ,Cholesteryl ester ,medicine ,030211 gastroenterology & hepatology ,business - Abstract
Lysosomal acid lipase (LAL) deficiency is a rare, autosomal recessive disease caused by mutations in the LIPA gene, which produces cholesteryl ester and triglyceride accumulation predominantly in hepatocytes, adrenal glands, and gastrointestinal tract. We describe two new cases occurring in siblings, aged 5 and 7 years, who presented with hepatomegaly, dyslipidemia, and abnormal liver function. Percutaneous liver biopsy revealed portal inflammation, hypertrophic Kupffer cells with a foamy appearance and microvesicular steatosis with fibrosis. Immunostaining for lysosomal markers, cathepsin D and LAMP1 reflected the lysosomal nature of the lipid vacuoles. After enzymatic confirmation, enzyme replacement therapy was initiated for both siblings. Follow-up transaminase levels and lipid profiles showed a notable decrease in AST and ALT and a slight increase in HDL cholesterol. It is crucial to increase awareness of this rare condition among clinicians and pathologists. The expression of lysosomal markers around the lipid vacuoles might help diagnose LAL deficiency in pediatric patients.
- Published
- 2023