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Chronic Intestinal Pseudo-Obstruction and Neurological Manifestations in Early Adulthood: Considering MNGIE Syndrome in Differential Diagnosis
Chronic Intestinal Pseudo-Obstruction and Neurological Manifestations in Early Adulthood: Considering MNGIE Syndrome in Differential Diagnosis
1) Department of Gastroenterology, Turkiye Yuksek Ihtisas Education and Research Hospital; 2) Department of Medical
Biology, Hacettepe University School of Medicine, Ankara, Turkey
Discussion
MNGIE syndrome is a multisystemic disorder with
manifestations in mitochondrial DNA, which results in
intestinal pseudo-obstruction and neuro-ophthalmologic
abnormalities and caused by mutations in the thymidine
phosphorylase gene [4, 5]. Clinical presentation can be
variable. Approximately 45-67% of patients have had a
gastrointestinal complaint as the presenting symptom,
including nausea, vomiting, abdominal pain, diarrhea and
weight loss. Most of these symptoms suggest a possible
malabsorption syndrome. If neurologic symptoms are
Fig 2. After diluted barium ingestion, radiography present, GSE should be involved in the differential diagnosis
showed diffuse thickening of the small intestinal
because GSE long has been associated with neurologic and
walls. The mucosal folds could not be observed
clearly, but the passage appeared to be normal. psychiatric disorders including cerebellar ataxia, peripheral
neuropathy, epilepsy, dementia, and depression [6].
Although clinical manifestations are relatively constant
Based on the phenotypic manifestations, radiological in MNGIE syndrome, age of onset and disease progression
findings and also the family history, MNGIE disorder was are quite variable. These symptoms determine physicians to
suspected. For the definitive diagnosis we performed genetic misdiagnose the condition as a malabsorption syndrome such
testing. Genomic DNA was extracted from peripheral as GSE, as happened in our patient. Although he had a strong
blood using standard procedures. DNA samples were PCR family history, he could not be diagnosed previously because
amplified using sequence specific primers for the coding the other members of the family, affected by MNGIE, could
Chronic intestinal pseudo-obstruction and neurological manifestations 197