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Introdução: Mucopolissacaridose tipo IV (MPS IV) é uma doença hereditária autossômica recessiva de armazenamento lisossômico devido a mutações no gene N-acetilgalactosamina-6-sulfatase (GALNS). Sua incidência é de 1 em 75.000 a 1 em 200.000 nascimentos, com distribuição igual em homens e mulheres (1). O diagnóstico é baseado em manifestações clínicas, achados radiológicos, testes bioquímicos e detecção molecular. Infelizmente, não há cura para MPS IVA; embora terapias experimentais tenham sido implementadas recentemente e novos tratamentos estejam em desenvolvimento.


Apresentação do caso: Serão apresentados dois pacientes irmãos com diagnóstico tardio de Mucopolissacaridose tipo IVA, os primeiros 41 anos, sexo feminino com manifestações esqueléticas como cifoescoliose, osteocondrodisplasia C2/C3, pectus carinatum, doença de Perthes bilateral, pés planos e limitações esqueléticas, amplitude de movimento e marcha, apneia obstrutiva do sono, características faciais atípicas e baixa estatura. O segundo, 41 anos, sexo masculino, fronte larga, nariz côncavo, alterações dentárias, cifoescoliose, pectus carinatum, extremidades encurtadas, dor ao movimentar as mãos, marcha limitada e pés chatos. Em ambos, uma variante homozigótica no gene GALNS de significado clínico incerto (VUS) foi identificada no exoma, c.850 T>G p. (Phe284Val).


Discussão: A mucopolissacaridose tipo IVA é uma doença heterogénea com um espectro diverso. Nossos casos contribuem para a literatura local e internacional por apresentarem manifestações clínicas e esqueléticas típicas dessa patologia, bem como confirmação diagnóstica molecular.

Gutierrez Vargas, M. C., & Ostos Alfonso, H. (2026). Diagnóstico tardio de mucopolissacaridose tipo IV A em dois irmãos no sul colombiano. Revista Ciencias De La Salud, 23(3), 1–9. https://doi.org/10.12804/revistas.urosario.edu.co/revsalud/a.13480

Hung S, Hernández G, Briceño Y, Silvestre R, Barrios MC. Morquio Syndrome as a rare cause of disproportionate short stature: Pathophysiological, diagnostic and therapeutic approach. About a case. Revista Venezolana de Endocrinología y Metabolismo [Internet]. 2016 [cited 2023 May 4];14(3):217–25. Available from: http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S1690-31102016000300007&lng=es&nrm=iso&tlng=es

Cadena Arteaga JA, Lasso Andrade FA, Achicanoy Puchana DM, Achicanoy Puchana DF, Caicedo Morillo GN, Medina Bravo PA, et al. Mucopolysaccharidosis type IV: report of 5 cases of Morquio Syndrome. Radiol Case Rep [Internet]. 2021 Feb 1 [cited 2023 May 3];17(2):385–91. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.uniandes.edu.co/34925671/ DOI: https://doi.org/10.1016/j.radcr.2021.11.012

Sawamoto K, González JVÁ, Piechnik M, Otero FJ, Couce ML, Suzuki Y, et al. Mucopolysaccharidosis IVA: Diagnosis, Treatment, and Management. Int J Mol Sci [Internet]. 2020 Feb 2 [cited 2023 May 3];21(4). Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.uniandes.edu.co/32102177/ DOI: https://doi.org/10.3390/ijms21041517

Padash S, Obaid H, Henderson RDE, Padash Y, Adams SJ, Miller SF, et al. A pictorial review of the radiographic skeletal findings in Morquio syndrome (mucopolysaccharidosis type IV). Pediatr Radiol [Internet]. 2023 [cited 2023 May 3];53(5). Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.uniandes.edu.co/36627376/ DOI: https://doi.org/10.1007/s00247-022-05585-3

Zanetti A, D’Avanzo F, AlSayed M, Brusius-Facchin AC, Chien YH, Giugliani R, et al. Molecular basis of mucopolysaccharidosis IVA (Morquio A syndrome): A review and classification of GALNS gene variants and reporting of 68 novel variants. Hum Mutat [Internet]. 2021 Nov 1 [cited 2023 May 3];42(11):1384–98. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.uniandes.edu.co/34387910/ DOI: https://doi.org/10.1002/humu.24270

Nelson J, Crowhurst J, Carey B, Greed L. Incidence of the mucopolysaccharidoses in Western Australia. Am J Med Genet A [Internet]. 2003 Dec 15 [cited 2023 May 4];123A(3):310–3. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.uniandes.edu.co/14608657/ DOI: https://doi.org/10.1002/ajmg.a.20314

Khan SA, Peracha H, Ballhausen D, Wiesbauer A, Rohrbach M, Gautschi M, et al. Molecular Genetics and Metabolism. Mol Genet Metab [Internet]. 2017 Jul 1 [cited 2023 May 4];121(3):227. Available from: /pmc/articles/PMC5653283/ DOI: https://doi.org/10.1016/j.ymgme.2017.05.016

Instituto Nacional de Salud de Colombia. Comportamiento epidemiológico de las enfermedades huérfanas. Colombia, 2016 hasta semana epidemiológica 05 de 2019 [Internet]. 2016 hasta semana epidemiológica 05 de 2019. 2019 [cited 2023 May 4]. p. 4–27. Available from: https://www.ins.gov.co/buscador-eventos/BoletinEpidemiologico/2019%20Bolet%C3%ADn%20epidemiol%C3%B3gico%20semana%205.pdf

Pachajoa H, Rodriguez C. Possible case of sirenomelia in the Tumaco-Tolita pottery pre-Columbian culture, 2000 years before the epidemic focus of sirenomelia in Cali-Colombia. Am J Med Genet A. 2011 Sep;155(9):2327–8. DOI: https://doi.org/10.1002/ajmg.a.32923

Leong HY, Abdul Azize NA, Chew HB, Keng WT, Thong MK, Mohd Khalid MKN, et al. Clinical, biochemical and genetic profiles of patients with mucopolysaccharidosis type IVA (Morquio A syndrome) in Malaysia: the first national natural history cohort study. Orphanet J Rare Dis [Internet]. 2019 Jun 14 [cited 2023 May 4];14(1). Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.uniandes.edu.co/31200731/ DOI: https://doi.org/10.1186/s13023-019-1105-6

Holzgreve W, Gröbe H, von Figura K, Kresse H, Beck H, Mattei JF. Morquio syndrome: clinical findings in 11 patients with MPS IVA and 2 patients with MPS IVB. Hum Genet [Internet]. 1981 Jul [cited 2023 May 4];57(4):360–5. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.uniandes.edu.co/6793501/ DOI: https://doi.org/10.1007/BF00281685

Theroux MC, Nerker T, Ditro C, MacKenzie WG. Anesthetic care and perioperative complications of children with Morquio syndrome. Pediatric Anesthesia [Internet]. 2012 Sep 1 [cited 2023 May 4];22(9):901–7. Available from: https://onlinelibrary-wiley-com.ezproxy.uniandes.edu.co/doi/full/10.1111/j.1460-9592.2012.03904.x DOI: https://doi.org/10.1111/j.1460-9592.2012.03904.x

Tomatsu S, M. Montano A, Oikawa H, J. Rowan D, Smith M, Barrera L, et al. Mucopolysaccharidosis type IVA (Morquio A disease): clinical review and current treatment. Curr Pharm Biotechnol [Internet]. 2011 May 2 [cited 2023 May 4];12(6):931–45. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.uniandes.edu.co/21506915/ DOI: https://doi.org/10.2174/138920111795542615

Montaño AM, Tomatsu S, Gottesman GS, Smith M, Orii T. International Morquio A Registry: clinical manifestation and natural course of Morquio A disease. J Inherit Metab Dis [Internet]. 2007 Apr [cited 2023 May 4];30(2):165–74. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.uniandes.edu.co/17347914/ DOI: https://doi.org/10.1007/s10545-007-0529-7

Pachajoa H, Ruiz-Botero F, Hernández-Amariz MF, Eichler S, Castillo-Giraldo AO. Síndrome de Morquio: nueva mutación del gen GALNS en dos hermanos del sur-occidente colombiano. Análisis clínico, molecular y bioinformático. Revista Mexicana de Pediatría [Internet]. 2016 Sep 5 [cited 2023 May 4];83(3):85–92. Available from: http://www.uniprot.org/uniprot/P34059

Morrone A, Tylee KL, Al-Sayed M, Brusius-Facchin AC, Caciotti A, Church HJ, et al. Molecular Testing of 163 Patients with Morquio A (Mucopolysaccharidosis IVA) Identifies 39 Novel GALNS Mutations. Mol Genet Metab [Internet]. 2014 [cited 2023 May 5];112(2):160. Available from: /pmc/articles/PMC4203673/ DOI: https://doi.org/10.1016/j.ymgme.2014.03.004

Peracha H, Sawamoto K, Averill L, Kecskemethy H, Theroux M, Thacker M, et al. Molecular Genetics and Metabolism Special Edition: Diagnosis Diagnosis and Prognosis of Mucopolysaccharidosis IVA. Mol Genet Metab [Internet]. 2018 Sep 1 [cited 2023 May 5];125(1–2):18. Available from: /pmc/articles/PMC6175643/ DOI: https://doi.org/10.1016/j.ymgme.2018.05.004

Hendriksz CJ, Harmatz P, Beck M, Jones S, Wood T, Lachman R, et al. Review of Clinical Presentation and Diagnosis of Mucopolysaccharidosis IVA. Mol Genet Metab [Internet]. 2013 Sep [cited 2023 May 5];110(0):54. Available from: /pmc/articles/PMC3755102/ DOI: https://doi.org/10.1016/j.ymgme.2013.04.002

Shapiro EG, Eisengart JB. The natural history of neurocognition in MPS disorders: A review. Mol Genet Metab [Internet]. 2021 May 1 [cited 2023 May 5];133(1):8–34. Available from: https://pubmed-ncbi-nlm-nih-gov.ezproxy.uniandes.edu.co/33741271/ DOI: https://doi.org/10.1016/j.ymgme.2021.03.002

Harmatz P, Mengel KE, Giugliani R, Valayannopoulos V, Lin SP, Parini R, et al. The Morquio A Clinical Assessment Program: baseline results illustrating progressive, multisystemic clinical impairments in Morquio A subjects. Mol Genet Metab [Internet]. 2013 May [cited 2023 May 5];109(1):54–61. Available from: https://pubmed.ncbi.nlm.nih.gov/23452954/ DOI: https://doi.org/10.1016/j.ymgme.2013.01.021

Ailabouni R, Zomar BO, Slobogean BL, Schaeffer EK, Joseph B, Mulpuri K. The Natural History of Non-operatively Managed Legg–Calvé–Perthes’ Disease. Indian J Orthop [Internet]. 2022 May 1 [cited 2023 May 5];56(5):867. Available from: /pmc/articles/PMC9043051/ DOI: https://doi.org/10.1007/s43465-021-00543-x

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