DOI QR코드

DOI QR Code

Early Diagnosis of Fabry Disease in a Patient with Toe Tip Pain

  • Park, Ki-Bum (Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University) ;
  • Han, Kyung-Ream (Department of Anesthesiology and Pain Medicine, College of Medicine, Ajou University) ;
  • Lee, Jae-Woo (Department of Anesthesiology and Pain Medicine, College of Medicine, Eulji University, Eulji Hospital) ;
  • Kim, Seung-Ho (Department of Anesthesiology and Pain Medicine, College of Medicine, Konyang University) ;
  • Kim, Do-Wan (Department of Anesthesiology and Pain Medicine, College of Medicine, Ajou University) ;
  • Kim, Chan (Department of Anesthesiology and Pain Medicine, College of Medicine, Ajou University) ;
  • Ko, Jung-Min (Department of Medical Genetics, Ajou University Hospital, College of Medicine, Ajou University)
  • Received : 2010.05.26
  • Accepted : 2010.07.29
  • Published : 2010.09.01

Abstract

Fabry disease is an X-linked lysosomal disease caused by deficiency of ${\alpha}$-galactosidase, in which early diagnosis may be missed due to the wide variety of clinical symptoms presenting during disease progression. A 13 year-old boy visited our pain clinic complaining of pricking and burning pain in the toe tips of both feet. Continuous epidural infusion for pain management was performed because of oral analgesics ineffectiveness. The patient underwent ${\alpha}$-galactosidase A (GLA) enzyme analysis based on the clinical impression of Fabry disease from pain with a peripheral neuropathic component and history of anhidrosis. He was diagnosed with Fabry disease after confirming mutation of the GLA gene through a screening test of GLA activity. Enzyme replacement therapy was initiated and pain was tolerated with oral analgesics.

Keywords

References

  1. Brady RO, Gal AE, Bradley RM, Martensson E, Warshaw AL, Laster L. Enzymatic defect in Fabry's disease. Ceramidetrihexosidase deficiency. N Engl J Med 1967; 276: 1163-7. https://doi.org/10.1056/NEJM196705252762101
  2. Scriver CR. The metabolic & molecular bases of inherited disease. 8th ed. New York, McGraw-Hill. 2001, pp 3733-74.
  3. Eng CM, Fletcher J, Wilcox WR, Waldek S, Scott CR, Sillence DO, et al. Fabry disease: baseline medical characteristics of a cohort of 1765 males and females in the Fabry Registry. J Inherit Metab Dis 2007; 30: 184-92. https://doi.org/10.1007/s10545-007-0521-2
  4. Meikle PJ, Hopwood JJ, Clague AE, Carey WF. Prevalence of lysosomal storage disorders. JAMA 1999; 281: 249-54. https://doi.org/10.1001/jama.281.3.249
  5. Ramaswami U, Whybra C, Parini R, Pintos-Morell G, Mehta A, Sunder-Plassmann G, et al. Clinical manifestations of Fabry disease in children: data from the Fabry Outcome Survey. Acta Paediatr 2006; 95: 86-92.
  6. Ries M, Ramaswami U, Parini R, Lindblad B, Whybra C, Willers I, et al. The early clinical phenotype of Fabry disease: a study on 35 European children and adolescents. Eur J Pediatr 2003; 162: 767-72. https://doi.org/10.1007/s00431-003-1299-3
  7. Manger B, Mengel E, Schaefer RM. Rheumatologic aspects of lysosomal storage diseases. Clin Rheumatol 2007; 26: 335-41. https://doi.org/10.1007/s10067-006-0299-x
  8. Mehta A, Ricci R, Widmer U, Dehout F, Garcia de Lorenzo A, Kampmann C, et al. Fabry disease defined: baseline clinical manifestations of 366 patients in the Fabry Outcome Survey. Eur J Clin Invest 2004; 34: 236-42. https://doi.org/10.1111/j.1365-2362.2004.01309.x
  9. Wozniak MA, Kittner SJ, Tuhrim S, Cole JW, Stern B, Dobbins M, et al. Frequency of unrecognized Fabry disease among young European-American and African-American men with first ischemic stroke. Stroke 2010; 41: 78-81. https://doi.org/10.1161/STROKEAHA.109.558320
  10. Kotanko P, Kramar R, Devrnja D, Paschke E, Voigtlä5nder T, Auinger M, et al. Results of a nationwide screening for Anderson-Fabry disease among dialysis patients. J Am Soc Nephrol 2004; 15: 1323-9. https://doi.org/10.1097/01.ASN.0000124671.61963.1E
  11. Marchesoni CL, Roa N, Pardal AM, Neumann P, Cáeceres G, Martírnez P, et al. Misdiagnosis in Fabry disease. J Pediatr 2010; 156: 828-31. https://doi.org/10.1016/j.jpeds.2010.02.012
  12. Paira SO, Roverano S, Iribas JL, BarcelóHA. Joint manifestations of Fabry's disease. Clin Rheumatol 1992; 11: 562-5. https://doi.org/10.1007/BF02283120
  13. Madden S, Kelly L. Update on acute rheumatic fever: it still exists in remote communities. Can Fam Physician 2009; 55: 475-8.
  14. Hoffmann B, Beck M, Sunder-Plassmann G, Borsini W, Ricci R, Mehta A; FOS European Investigators. Nature and prevalence of pain in Fabry disease and its response to enzyme replacement therapy-a retrospective analysis from the Fabry Outcome Survey. Clin J Pain 2007; 23: 535-42. https://doi.org/10.1097/AJP.0b013e318074c986
  15. Hoffmann B, Garcia de Lorenzo A, Mehta A, Beck M, Widmer U, Ricci R; FOS European Investigators. Effects of enzyme replacement therapy on pain and health related quality of life in patients with Fabry disease: data from FOS (Fabry Outcome Survey). J Med Genet 2005; 42: 247-52. https://doi.org/10.1136/jmg.2004.025791
  16. Hoffmann B, Schwarz M, Mehta A, Keshav S; Fabry Outcome Survey European Investigators. Gastrointestinal symptoms in 342 patients with Fabry disease: prevalence and response to enzyme replacement therapy. Clin Gastroenterol Hepatol 2007; 5: 1447-53. https://doi.org/10.1016/j.cgh.2007.08.012
  17. Feriozzi S, Schwarting A, Sunder-Plassmann G, West M, Cybulla M; International Fabry Outcome Survey Investigators. Agalsidase alfa slows the decline in renal function in patients with Fabry disease. Am J Nephrol 2009; 29: 353-61. https://doi.org/10.1159/000168482
  18. Hughes DA, Elliott PM, Shah J, Zuckerman J, Coghlan G, Brookes J, et al. Effects of enzyme replacement therapy on the cardiomyopathy of Anderson-Fabry disease: a randomised, double-blind, placebo-controlled clinical trial of agalsidase alfa. Heart 2008; 94: 153-8. https://doi.org/10.1136/hrt.2006.104026
  19. Wraith JE, Tylki-Szymanska A, Guffon N, Lien YH, Tsimaratos M, Vellodi A, et al. Safety and efficacy of enzyme replacement therapy with agalsidase beta: an international, open-label study in pediatric patients with Fabry disease. J Pediatr 2008; 152: 563-70. https://doi.org/10.1016/j.jpeds.2007.09.007
  20. Banikazemi M, Bultas J, Waldek S, Wilcox WR, Whitley CB, McDonald M, et al. Agalsidase-beta therapy for advanced Fabry disease: a randomized trial. Ann Intern Med 2007; 146: 77-86. https://doi.org/10.7326/0003-4819-146-2-200701160-00148

Cited by

  1. Pain management strategies for neuropathic pain in Fabry disease - a systematic review vol.16, pp.1, 2016, https://doi.org/10.1186/s12883-016-0549-8
  2. Fabry disease in children: a federal screening programme in Russia vol.176, pp.10, 2017, https://doi.org/10.1007/s00431-017-2992-y
  3. Fabry disease: Inherited deficiency of a lysosomal enzyme due to a Xq22 mutation with possible enzyme replacement therapy vol.78, pp.4, 2010, https://doi.org/10.1016/j.monrhu.2011.06.006