Title: Menkes Syndrome:  A Case Report

Authors: Dr Asma Arif Hussain, Dr Ahlaam Arif Hussain

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i4.190

Abstract

Menkes disease is a rare x-linked recessive disorder of copper metabolism characterized by neurodegeneration and brittle kinky hair. We are presenting a case of a 7 month old male infant who was admitted to the hospital with history of convulsions since 4 months of age along with history of on and off cold since 5 months of age. Infant had delayed milestones for his age and truncal hypotonia. The infant had fair complexion with cherubic appearance along with light colored fuzzy, brittle and sparse hair. Based on clinical presentation, menkes disease was suspected and hence serum copper and ceruloplasmin levels were also checked along with the routine blood profile. Routine blood profile analysis were normal  but serum copper  and ceruloplasmin levels were found to be low. Serum copper was 80.77ug/dl and serum ceruloplasmin was <8mg/dl. Light microscopic examination of brittle kinky hair showed pili torti (flattened and twisted hair). MRI showed prominent extraaxial spaces with gliosis. Based on clinical appearance, hair microscopy findings, low serum copper and ceruloplasmin levels, infant was diagnosed as a case of Menkes disease and was managed symptomatically. Genetic study could not be done due to lack of facilities.

Keywords: Menkes disease, Copper, Ceruloplasmin, Pili Torti.

References

  1. Menkes JH. Kinky hair disease, Pediatrics 1972;50(2):181-3.
  2. M Barzegar, Fayyazie A et al. Menkes Disease: Report of Two Cases. Iran J Pediatr 2007;17(4):388-392.
  3. Kirodian BG, Gogtay NJ, Udani VP, Kashirsagar NA. Treatment of Menkes disease with parental copper histidine. Indian Pediatrics 2002; 39:183-185.
  4. Drank DM, Cartwright E, Stevens BJ, Townley RR. Menke's kinkey hair disease: Further definition of the defect in copper transport. Science 1973; 79(78):1140-2. [Medline].
  5. Menkes JH, Alter M, Steigleder GK et al. A sex-linked recessive disorder with retardation of growth, peculiar hair, and focal cerebral and cerebellar degeneration. Pediatrics 1962; 29:764-779.
  6. Danks DM, Campbell PE, Stevens BJ et al. Menkes kinky hair syndrome: An inherited defect in copper absorption with widespread effects. Pediatr 1972;50(2): 188-201.
  7. Chelly J, Tumer Z, Tonnesen T et al. Isolation of a candidate gene for  Menkes disease that encodes a potential heavy metal binding protein. Nat Genet 1993;3:14-19.
  8. Voskoboinik I, Camakaris J. Menkes copper-translocating P-type ATPase (ATP7A): biochemical and cell biology properties and role in Menkes disease. J Bioenerg Biomembr 2002;34:363-371.
  9. Datta AK, Ghosh T, Nayak K, Ghos Mrinalkanti. Menkes kinky hair disease: A case report. Cases Journal 2008; 1:158.
  10. Aicardi J. Menkes disease (kinky hair disease, steely hair disease, trichopoliodystrophy). In: Aicardi J (ed). Diseases of the nervous system in childhood. 2nd ed . London: Mac Keith Press; 1998. p.306-308.
  11. Menkes JH. Kinky hair disease: twenty five years later. Brain Dev 1998;10(2):77-9.
  12. Proud VK, Mussell HG, Kaler SG et al. Distinctive Menkes disease variant with occipital horns: delineation of natural history and clinical phenotype. Am J Med Genet 1996; 65(1):44-51.
  13. Whiting DA. Structural abnormalities of the hair shaft. J Am Acad Dermatol 1987;16(1.1):1-25.
  14. Menkes JH, Wilcox WR. Inherited metabolic disease of the nervous system. In: Menkes JH, Sarnat HB, Maria BL, (eds). Child Neurology. 7th ed. Philadelphia: Lippimcott Williams & Wilkins; 2006. p.115-7.
  15. Kodama H, Murata Y, Kobayashi M. Clinical manifestations and treatment of Menkes disease and its variants. Pediatr Int 1999;41:423-429.
  16. Gu YU, Kodama H, Sato E et al. Prenatal diagnosis of Menkes disease by genetic analysis and copper measurement. Brain Dev 2002; 24(7):715-8.

Corresponding Author

Dr Asma Arif Hussain

KIMS, Karad