Autopsy and Case Reports
https://www.autopsyandcasereports.org/article/doi/10.4322/acr.2021.334
Autopsy and Case Reports
Autopsy Case Report

Leigh syndrome in an infant: autopsy and histopathology findings

Arushi Gahlot Saini; Debjyoti Chatterjee; Chandana Bhagwat; Sameer Vyas; Savita Verma Attri

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Abstract

Leigh syndrome is an inherited neurodegenerative disorder of infancy that typically manifests between 3 and 12 months of age. The common neurological manifestations are developmental delay or regression, progressive cognitive decline, dystonia, ataxia, brainstem dysfunction, epileptic seizures, and respiratory dysfunction. Although the disorder is clinically and genetically heterogeneous, the histopathological and radiological features characteristically show focal and bilaterally symmetrical, necrotic lesions in the basal ganglia and brainstem. The syndrome has a characteristic histopathological signature that helps in clinching the diagnosis. We discuss these unique findings on autopsy and radiology in a young infant who succumbed to a subacute, progressive neurological illness suggestive of Leigh syndrome. Our case highlights that Leigh syndrome should be considered in the differential diagnosis of infantile-onset, subacute neuroregression with dystonia and seizures, a high anion gap metabolic acidosis, normal ketones, elevated lactates in blood, brain, and urine, and bilateral basal ganglia involvement.

Keywords

Basal Ganglia, Brain Damage, Chronic, Leigh Disease, Mitochondrial Diseases

References

1 Leigh D. Subacute necrotizing encephalomyelopathy in an infant. J Neurol Neurosurg Psychiatry. 1951;14(3):216-21. http://dx.doi.org/10.1136/jnnp.14.3.216. PMid:14874135.

2 Chang X, Wu Y, Zhou J, Meng H, Zhang W, Guo J. A meta-analysis and systematic review of Leigh syndrome: clinical manifestations, respiratory chain enzyme complex deficiency, and gene mutations. Medicine. 2020;99(5):e18634. http://dx.doi.org/10.1097/MD.0000000000018634. PMid:32000367.

3 Lake NJ, Bird MJ, Isohanni P, Paetau A. Leigh syndrome: neuropathology and pathogenesis. J Neuropathol Exp Neurol. 2015;74(6):482-92. http://dx.doi.org/10.1097/NEN.0000000000000195. PMid:25978847.

4 Ventura F, Rocca G, Gentile R, De Stefano F. Sudden death in Leigh syndrome: an autopsy case. Am J Forensic Med Pathol. 2012;33(3):259-61. http://dx.doi.org/10.1097/PAF.0b013e31824e5be0. PMid:22441409.

5 Wick R, Scott G, Byard RW. Mechanisms of unexpected death and autopsy findings in Leigh syndrome (subacute necrotising encephalomyelopathy). J Forensic Leg Med. 2007;14(1):42-5. http://dx.doi.org/10.1016/j.jcfm.2006.01.002. PMid:16488174.

6 Schubert Baldo M, Vilarinho L. Molecular basis of Leigh syndrome: a current look. Orphanet J Rare Dis. 2020;15(1):31. http://dx.doi.org/10.1186/s13023-020-1297-9. PMid:31996241.

7 Saini A, Sharma S. Biotin-thiamine-responsive basal ganglia disease in children: a treatable neurometabolic disorder. Ann Indian Acad Neurol. 2021;24(2):173-7. PMid:34220059.

8 Nolt B, Tu F, Wang X, et al. Lactate and Immunosuppression in Sepsis. Shock. 2018;49(2):120-5. http://dx.doi.org/10.1097/SHK.0000000000000958. PMid:28767543.

9 Mak SC, Chi CS, Tsai CR. Mitochondrial DNA 8993 T > C mutation presenting as juvenile Leigh syndrome with respiratory failure. J Child Neurol. 1998;13(7):349-51. http://dx.doi.org/10.1177/088307389801300709. PMid:9701486.

10 Chinnery PF, DiMauro S. Mitochondrial hepatopathies. J Hepatol. 2005;43(2):207-9. http://dx.doi.org/10.1016/j.jhep.2005.05.012. PMid:15964657.

11 Sofou K, De Coo IF, Isohanni P, et al. A multicenter study on Leigh syndrome: disease course and predictors of survival. Orphanet J Rare Dis. 2014;9(1):52. http://dx.doi.org/10.1186/1750-1172-9-52. PMid:24731534.

12 Wortmann S, Rodenburg RJ, Huizing M, et al. Association of 3-methylglutaconic aciduria with sensori-neural deafness, encephalopathy, and Leigh-like syndrome (MEGDEL association) in four patients with a disorder of the oxidative phosphorylation. Mol Genet Metab. 2006;88(1):47-52. http://dx.doi.org/10.1016/j.ymgme.2006.01.013. PMid:16527507.
 


Submitted date:
06/27/2021

Accepted date:
09/14/2021

Publication date:
11/12/2021

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