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CASE REPORT
Treatable Leigh-like encephalopathy presenting in adolescence
  1. Elisa Fassone1,
  2. Yehani Wedatilake1,
  3. Catherine J DeVile2,
  4. W Kling Chong3,
  5. Lucinda J Carr2,
  6. Shamima Rahman1,4
  1. 1Mitochondrial Research Group, UCL Institute of Child Health, London, UK
  2. 2Department of Neurology, Great Ormond Street Hospital, London, UK
  3. 3Department of Radiology, Great Ormond Street Hospital, London, UK
  4. 4Metabolic Medicine Department, Great Ormond Street Hospital, London, UK
  1. Correspondence to Dr Shamima Rahman, shamima.rahman{at}ucl.ac.uk

Summary

Wernicke's encephalopathy is a triad of ophthalmoplegia, ataxia and confusion seen in alcoholics with dietary vitamin B1 (thiamine) deficiency. A rare genetic defect of thiamine transporter-2 may lead to similar clinical features, biotin-thiamine responsive basal ganglia disease (BTBGD). A 15-year-old girl developed rapid onset ptosis and ophthalmoplegia evolving into a subacute encephalopathy. Neuroimaging demonstrated symmetrical basal ganglia and mid-brain lesions reminiscent of Leigh's subacute necrotising encephalomyelopathy. Oral biotin and thiamine were started, and symptoms improved dramatically the next day. The therapeutic response suggested SLC19A3, encoding thiamine transporter-2, as a strong candidate gene and Sanger sequencing revealed a novel homozygous c.517A>G;p.Asn173Asp mutation, which segregated with disease within the family. BTBGD is a potentially treatable neurological disorder and should be considered in the differential diagnosis of Leigh syndrome and Wernicke's encephalopathy. Since delayed treatment results in permanent neurological dysfunction or death, prompt diagnosis and early initiation of biotin and thiamine therapy are essential.

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