Use of dexamethasone in acute rhabdomyolysis in LPIN1 deficiency

Mehdi Yeganeh; Kaitlin March; Catherine Jones; Gloria Ho; Kathryn A Selby; Jean-Pierre Chanoine; Sylvia Stockler; Ramona Salvarinova; Gabriella Horvath; Catherine Brunel-Guitton

doi:10.1016/j.ymgmr.2023.100961

Use of dexamethasone in acute rhabdomyolysis in LPIN1 deficiency

Mol Genet Metab Rep. 2023 Mar 10:35:100961. doi: 10.1016/j.ymgmr.2023.100961. eCollection 2023 Jun.

Affiliations

¹ Division of Biochemical Genetics, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver V6H 3N1, BC, Canada.
² Division of Neurology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, V6H 3N1, BC, Canada.
³ Division of Endocrinology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, V6H 3N1, BC, Canada.

Abstract

Introduction: LPIN1 deficiency is an autosomal recessive form of early childhood recurrent severe rhabdomyolysis. Although not completely lucid yet, LPIN1 has been shown to modulate endosomal-related pro-inflammatory responses via peroxisome proliferator-activated receptor α (PPARα) and PPARγ coactivator 1α (PGC-1α). Treatment with anti-inflammatory agents such as dexamethasone has been proposed to improve the outcome.

Case: We report a male toddler with recurrent episodes of complicated rhabdomyolysis, requiring prolonged intensive care unit admissions. Whole exome sequencing revealed a common homozygous 1.7 kb intragenic deletion in LPIN1. Despite optimal metabolic cares, the patient presented with an extremely high CK level where he benefited from intravenous dexamethasone (0.6 mg/Kg/day) for a period of 6 days.

Results: Dexamethasone administration shortened the course of active rhabdomyolysis, intensive care admission and rehabilitation. It also prevented rhabdomyolysis-related complications such as kidney injury and compartment syndrome.

Conclusion: Our patient showed a favorable response to parenteral dexamethasone, in addition to hyperhydration with IV fluids, sufficient calorie intake, and restricted dietary fat. The improvement with corticosteroids suggests an uncontrolled inflammatory response as the pathophysiology of LPIN1 deficiency.

Keywords: Dexamethasone; Hereditary rhabdomyolysis; LPIN1.

Publication types

Case Reports