Propionic acidemia: Case report

Abstract

A three and a half-month-old boy was referred to us to be investigated due to pancytopenia. He had vomiting, lethargy and failure to thrive. It was reported that seventy two hours after an uneventful labor, he developed feeding difficulty, vomiting, hypotonia and lethargy; and he was hospitalized with an initial diagnosis of neonatal sepsis for 15 days. There was second degree consanguinity between his parents.On physical examination; he was hypotonic, lethargic, and tachypneic with a slight hepatomegaly of 2 cm. Neonatal reflexes were absent. During follow-up, he developed persistent myoclonic convulsions and metabolic acidosis. Quantitative plasma and cerebrospinal fluid glycine levels were increased. On tandem mass spectrometric study, C3-propionyl carnitin level was increased. Urine organic acid analysis revealed increased 3-OH propionic acid, 3-OH butyric acid, and propionylglycine levels. He was diagnosed as propionic acidemia and a protein restricted diet with oral L-carnitine and biotin supplementations were started.In our country, where the prevalence of consanguineous marriages is very high, inborn errors of metabolism should be strongly considered in all of those full term neonates and children who develop hypotonia, convulsions, lethargy and failure to thrive after an uneventful labor, as well as in those developing signs and symptoms of neonatal sepsis without any risk factors both in the baby and in the mother.