The clinical variations and diagnostic challenges of deoxyguanosine kinase deficiency: a case series

Doğulu N., Tuna Kırsaçlıoğlu C., Köse E., Ünlüsoy Aksu A., Kuloğlu Z., Kansu Tanca A., ...More

JOURNAL OF PEDIATRIC ENDOCRINOLOGY & METABOLISM, vol.34, no.10, pp.1341-1347, 2021 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 34 Issue: 10
  • Publication Date: 2021
  • Doi Number: 10.1515/jpem-2021-0108
  • Journal Name: JOURNAL OF PEDIATRIC ENDOCRINOLOGY & METABOLISM
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, CAB Abstracts, EMBASE, MEDLINE
  • Page Numbers: pp.1341-1347
  • Keywords: DGUOK deficiency, liver failure, neonatal cholestasis, MITOCHONDRIAL-DNA DEPLETION
  • Ankara University Affiliated: Yes

Abstract

Objectives: Deoxyguanosine kinase (DGUOK) deficiency is one of the leading causes of the mitochondrial DNA-depletion syndromes (MDDS) associated with hepatocerebral involvement. Herein, we present four cases of DGUOK deficiency to emphasize the clinical variability of disease and the challenges in the diagnosis of DGUOK deficiency. Case presentation: Hepatomegaly, hyperlactatemia, elevated alpha fetoprotein (AFP), alanine, and transaminase levels were detected in all patients, and cholestasis, coagulopathy, and hypotonia were common findings. All patients had a low birth weight, one patient underwent liver transplantation (LT). Clinical and laboratory findings of two patients and one patient suggested neonatal hemochromatosis and type 1 tyrosinemia, respectively. All patients were diagnosed with DGUOK deficiency by performing molecular genetic analysis. Conclusions: Mitochondrial DNA-depletion syndromes should be kept in mind in cases in which hypotonicity, lactic acidosis, and neonatal cholestasis are observed.DGUOK deficiency may present in different clinics suggesting neonatal hemochromatosis or tyrosinemia type 1.