Ann Pediatr Endocrinol Metab.  2017 Mar;22(1):68-71. 10.6065/apem.2017.22.1.68.

A 1-month-old infant with chylomicronemia due to GPIHBP1 gene mutation treated by plasmapheresis

• Jung MK
• Jin J
• Kim HO
• Kwon A
• Chae HW
• Kang SJ
• Kim DH
• Kim HS

• KMID: 2409803
• DOI: http://doi.org/10.6065/apem.2017.22.1.68

Abstract

Chylomicronemia is a severe type of hypertriglyceridemia characterized by chylomicron accumulation that arises from a genetic defect in intravascular lipolysis. It requires urgent and proper management, because serious cases can be accompanied by pancreatic necrosis or persistent multiple organ failure. We present the case of a 1-month-old infant with chylomicronemia treated by plasmapheresis. His chylomicronemia was discovered incidentally when lactescent plasma was noticed during routine blood sampling during a hospital admission for fever and irritability. Laboratory investigation revealed marked triglyceridemia (>5,000 mg/dL) with high chylomicron levels. We therefore decided to perform a therapeutic plasmapheresis to prevent acute pancreatitis. Sequence analysis revealed a homozygous novel mutation in exon 4 of GPIHBP1: c.476delG (p.Gly159Alafs). Glycosylphosphatidylinositol-anchored high density lipoprotein-binding protein 1 (GPIHBP1) stabilizes the binding of chylomicrons near lipoprotein lipase and supports lipolysis. Mutations of GPIHBP1, the most recently discovered gene, can lead to severe hyperlipidemia and are known to make up only 2% of the monogenic mutations associated with chylomicronemia. The patient maintains mild hypertriglyceridemia without rebound after single plasmapheresis and maintenance fibrate medication so far. Here, we report an infant with chylomicronemia due to GPIHBP1 mutation, successfully treated by plasmapheresis.

Keyword

Chylomicronemia; GPIHBP1; Plasmapheresis

MeSH Terms

Chylomicrons
Exons
Fever
Humans
Hyperlipidemias
Hypertriglyceridemia
Infant*
Infant, Newborn*
Lipolysis
Lipoprotein Lipase
Multiple Organ Failure
Necrosis
Pancreatitis
Plasma
Plasmapheresis*
Sequence Analysis
Chylomicrons
Lipoprotein Lipase

Figure

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  Fig. 1 Plasma triglyceride and cholesterol levels before and after plasma exchange.

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  Fig. 2 The mutation of nucleotide sequence in GPIHBP1 gene in patient.

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