We describe a female infant born at term and delivered by emergency Caesarean section because of fetal distress.
There was no parental consanguinity.
She presented at 5 months of age with failure to thrive, microcephaly, hypertonia, and developmental impairment.
Her plasma and cerebrospinal fluid lactate were raised.
She had raised plasma pyruvate with a normal lactate-pyruvate ratio.
Magnetic resonance imaging of the brain showed a focal dilatation of the right lateral ventricle with unilateral periventricular leukomalacia (PVL) with subependymal cyst.
Skin fibroblast culture assay revealed PDH deficiency, confirmed by mutation analysis of the E1 alpha subunit.
At 18 months of age, she has hypertonia and global impairment and is making slow progress.
Denver II assessment showed delay in gross motor, fine motor, adaptive, personal, social, and language categories.
She has been treated with dichloroacetate and a ketogenic diet since the age of 10 and 13 months respectively, without any side effects.
To our knowledge, unilateral PVL as a neuroradiological feature has not been described in children with PDH deficiency. PDH deficiency should be considered as a differential diagnosis if PVL is unilateral and if the perinatal history is not typical of PVL.
JournalDevelopmental medicine and child neurology
Dev Med Child Neurol (1469-8749)
Department of Paediatric Neurology, Sheffield Children's Hospital, Sheffield, UK.
Dev Med Child Neurol. 2012 May;54(5):469-71
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