Phosphoglycerate mutase deficiency with tubular aggregates in a patient from Panama
Department of Neurology
Adult; Humans; Male; Muscle Cramp; Muscle Weakness; Muscle, Skeletal; Phosphoglycerate Mutase
Musculoskeletal Diseases | Nervous System Diseases | Neurology
INTRODUCTION: Phosphoglycerate mutase deficiency (PGAM) is a rare metabolic myopathy that results in terminal block in glycogenolysis. Clinically, patients with PGAM deficiency are asymptomatic, except when they engage in brief, strenuous efforts, which may trigger myalgias, cramps, muscle necrosis, and myoglobinuria. An unusual pathologic feature of PGAM deficiency is the association with tubular aggregates.
METHODS: We report an African-American patient from Panama with partial deficiency of PGAM who presented with asymptomatic elevation of creatine kinase levels and tubular aggregates on muscle biopsy.
RESULTS: Muscle biopsies showed subsarcolemmal and sarcolemmal tubular aggregates in type 2 fibers. Muscle PGAM enzymatic activity was decreased and gene sequencing revealed a heterozygous mutation in codon 78 of exon 1 of the PGAM2 gene, which is located on the short arm of chromosome 7.
CONCLUSIONS: PGAM deficiency has been reported in 14 patients, 9 of whom were of African-American ethnicity, and in 5 (36%) tubular aggregates were seen on muscle biopsy. Contrary to previously reported cases, our patient was initially asymptomatic. This further expands the PGAM deficiency phenotype.
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Citation: Muscle Nerve. 2013 Jan;47(1):138-40. doi: 10.1002/mus.23527. Epub 2012 Nov 21. Link to article on publisher's site
Muscle and nerve
Salameh, Johnny; Goyal, Namita; Choudry, Rabia; Camelo-Piragua, Sandra; and Chong, Peter Siao Tick, "Phosphoglycerate mutase deficiency with tubular aggregates in a patient from Panama" (2013). University of Massachusetts Medical School Faculty Publications. 238.