CONGENITAL GAUCHER DISEASE WITH NONIMMUNE HYDROPS/ERYTHROBLASTOSIS, INFANTILE ARTERIAL CALCIFICATION, AND NEONATAL HEPATITIS/FIBROSIS. CLINICOPATHOLOGIC REPORT WITH ENZYMATIC AND GENETIC ANALYSIS

Abstract

The findings in a stillborn female fetus of 31 weeks' gestation with congenital Gaucher disease, nonimmune hydrops/erythroblastosis, infantile arterial calcification, and neonatal hepatitis/fibrosis are presented, the first report of this complete constellation. Prior reports describe two similar patients. One lacked the hepatocellular features of giant cell hepatitis although manifesting hepatic fibrosis; the second lacked hepatic pathology. The diagnosis of Gaucher disease herein was established by microscopic examination of the proband, enzymatic analysis of trophoblast, and enzymatic and genetic study of the parents. The father was heterozygous for a recombinant glucocerebrosidase gene; the mother demonstrated a unique frame shift mutation. Thus the fetus is a compound heterozygote for a null and a severe mutation. Studies of parental DNA were negative for the D409H mutation of type IIIc Gaucher disease. Genetic studies were not performed of the ENPP1 gene, mutations of which are associated with idiopathic infantile arterial calcification.

Keywords:

• congenital Gaucher disease
• D409H mutation
• erythroblastosis fetalis
• hepatic fibrosis
• hydrops
• infantile arterial calcification
• neonatal hepatitis