Abstract
Navajo Neurohepatopathy (NNH) is a rare hepatocerebral mitochondrial DNA (mtDNA) depletion syndrome (MDS) with nonspecific clinical or pathologic features aside from Navajo ancestry. Because of the rarity of NNH, diagnosis rests on close clinicopathologic correlation and appropriate tissue triage for quantitative mtDNA analysis. We present a new case of NNH in which the clinical presentation and H&E liver biopsy histology indicated the need for NNH workup. Quantitative analysis of mtDNA in liver tissue was significantly reduced, and mutational analysis of the MPV17 gene confirmed homozygosity for the NNH-associated missense mutation, R50Q. The patient is now one year post liver transplant and continues to have normal liver function tests but suffers multiple immunosuppression-associated co-morbidities. A comprehensive literature review is provided to assist in diagnosis and management of NNH. (Acta gastroenterol. belg., 2016, 79, 463-469).
© Acta Gastro-Enterologica Belgica.
MeSH terms
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Biopsy / methods
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Diagnosis, Differential
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Disease Management
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Failure to Thrive / diagnosis*
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Failure to Thrive / etiology
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Heredodegenerative Disorders, Nervous System* / diagnosis
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Heredodegenerative Disorders, Nervous System* / genetics
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Heredodegenerative Disorders, Nervous System* / physiopathology
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Heredodegenerative Disorders, Nervous System* / therapy
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Humans
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Infant, Newborn
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Liver / pathology*
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Liver Diseases* / diagnosis
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Liver Diseases* / genetics
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Liver Diseases* / physiopathology
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Liver Diseases* / therapy
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Liver Transplantation / methods*
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Male
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Membrane Proteins / genetics*
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Mitochondrial Diseases* / diagnosis
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Mitochondrial Diseases* / genetics
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Mitochondrial Diseases* / physiopathology
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Mitochondrial Diseases* / therapy
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Mitochondrial Proteins / genetics*
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Mutation, Missense
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Peripheral Nervous System Diseases* / diagnosis
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Peripheral Nervous System Diseases* / genetics
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Peripheral Nervous System Diseases* / physiopathology
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Peripheral Nervous System Diseases* / therapy
Substances
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MPV17 protein, human
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Membrane Proteins
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Mitochondrial Proteins