Adult-Onset Ornithine Transcarbamylase Deficiency in a 51-Year-Old Man Who Presented With Fatal Hyperammonemic Encephalopathy

Typical male patients with ornithine transcarbamylase deficiency present in their early years with lethargy, seizure, and coma from hyperammonemia. An adult-onset phenotype, with sudden severe hyperammonemia emerging in otherwise-healthy men, has been increasingly recognized. We describe a character...

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Bibliographic Details
Main Authors: Bun Sheng, Ka Fai Yim, Tiffany Yan Lok Lam, Candace Yim Chan, Hencher Han Chih Lee
Format: Article
Language:English
Published: American College of Physicians 2024-05-01
Series:Annals of Internal Medicine: Clinical Cases
Online Access:https://www.acpjournals.org/doi/10.7326/aimcc.2023.1399
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Summary:Typical male patients with ornithine transcarbamylase deficiency present in their early years with lethargy, seizure, and coma from hyperammonemia. An adult-onset phenotype, with sudden severe hyperammonemia emerging in otherwise-healthy men, has been increasingly recognized. We describe a characteristic clinical course in a 51-year-old Chinese man who developed fatal hyperammonemia after receiving systemic corticosteroid for Bell's palsy. The genetic sequencing detected a novel missense variant NM_000531.6:c.642C>A (p.His214Gln) in the OTC gene. Inherited urea cycle disorders should be suspected in unexplained hyperammonemia at all ages with aggressive treatment initiated promptly before a diagnosis is confirmed.
ISSN:2767-7664