Korean J Pediatr.  2008 Nov;51(11):1236-1240. 10.3345/kjp.2008.51.11.1236.

A case of Smith-Lemli-Opitz syndrome diagnosed by identification of mutations in the 7-dehydrocholesterol reductase (DHCR7) gene

• Park MR
• Ko JM
• Cheon CK
• Kim GH
• Yoo HW

• KMID: 2280251
• DOI: http://doi.org/10.3345/kjp.2008.51.11.1236

Abstract

Smith-Lemli-Opitz syndrome (SLOS) is a rare, autosomal recessive disease caused by an inborn error in cholesterol synthesis. Patients with this disease suffer from multiple malformations due to reduced activity of 7-dehydrocholesterol reductase (DHCR7), which increases 7-dehydrocholesterol (7DHC) and 8-dehydrocholesterol (8DHC) concentrations and decreases cholesterol concentration in body fluids and tissue. The SLOS phenotypic spectrum ranges from a mild disorder with behavioral and learning problems to a lethal disease characterized by multiple malformations. Here, we describe a newborn male with ambiguous genitalia who was diagnosed to have type II SLOS during the neonatal period. A clinical examination revealed low levels of unconjugated estriol in the maternal serum, and a variety of fetal ultrasound anomalies, including prenatal growth retardation. After birth, the infant was diagnosed to have congenital heart disease (Tetralogy of Fallot with severe pulmonary artery stenosis), cleft lip and palate, micrognathia, postaxial polydactyly, ambiguous genitalia, and cataracts. Clinical investigation revealed extremely low plasma cholesterol levels and the presence of mutation (homozygote of p.Arg352Gln) in the DHCR7 gene. The patient underwent palliative heart surgery (to widen the pulmonary artery) and received intravenous lipid supplementation. Cholesterol levels increased slightly, but not to normal values. The patient died from cardiopulmonary failure and sepsis 72 days after birth. This report provides the first description of a Korean patient with SLOS confirmed by verification of DHCR7 gene mutation and illustrates the need for early recognition and appropriate diagnosis of this disease.

Keyword

Smith-Lemli-Opitz syndrome; Multiple malformations; 7-dehydrocholesterol reductase; Cholesterol

MeSH Terms

Body Fluids
Cataract
Cholestadienols
Cholesterol
Cleft Lip
Dehydrocholesterols
Disorders of Sex Development
Estriol
Heart Diseases
Humans
Infant
Infant, Newborn
Learning
Male
Oxidoreductases
Oxidoreductases Acting on CH-CH Group Donors
Palate
Parturition
Plasma
Polydactyly
Pulmonary Artery
Reference Values
Sepsis
Smith-Lemli-Opitz Syndrome
Thoracic Surgery
Cholestadienols
Cholesterol
Dehydrocholesterols
Estriol
Oxidoreductases
Oxidoreductases Acting on CH-CH Group Donors