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Non-ketotic hyperglycinaemia masquerading as a hypotonic-hyporesponsive episode following vaccination in an infant
  1. Arun Prasad,
  2. Pradeep Kumar,
  3. Giridhar Marithammanahalli Faneesha and
  4. Chandramohan Kumar
  1. Department of Pediatrics, All India Institute of Medical Sciences Patna, Patna, Bihar, India
  1. Correspondence to Dr Arun Prasad; drarunp{at}


Non-ketotic hyperglycinaemia (NKH) is an inborn error of glycine metabolism with autosomal recessive inheritance. A female infant presented to our emergency department with intractable seizures, lethargy and hypotonia, 2 weeks after her routine vaccination. Detailed infective and metabolic workup revealed normal blood sugar, ketone, lactate ammonia, and a high level of glycine in serum and cerebrospinal fluid suggesting NKH. Diagnosis of NKH was further confirmed on genetic analysis for AMT gene mutation. The child showed clinical improvement with oral sodium benzoate. Here, we report the inheritance, pathophysiology, diagnostic approach, genetic confirmation, management and prognosis of a child with NKH.

  • Paediatric intensive care
  • Epilepsy and seizures
  • Neurology (drugs and medicines)

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  • Correction notice Since this case report published online, the section has been updated from Geriatric medicine to Paediatrics.

  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content—AP, PK, GMF and CK. The following authors gave final approval of the manuscript—AP, PK, GMF and CK.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.