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A patient with typical clinical features of mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) but without an obvious genetic cause: a case report

Journal of Medical Case Reports. 2009;3(1):77 DOI 10.1186/1752-1947-3-77


Journal Homepage

Journal Title: Journal of Medical Case Reports

ISSN: 1752-1947 (Online)

Publisher: BMC

LCC Subject Category: Medicine

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF, HTML



Abu-Amero Khaled K

Al-Dhalaan Hesham

Bohlega Saeed

Hellani Ali

Taylor Robert W


Open peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 21 weeks


Abstract | Full Text

<p>Abstract</p> <p>Introduction</p> <p>There are currently 23 missense point mutations and one 4 basepair deletion spanning different mitochondrial genes associated with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS). The spectrum of mitochondrial DNA mutations in Arab patients with MELAS is largely unknown.</p> <p>Case presentation</p> <p>A standard clinical examination was carried out on a 34-year-old Saudi woman showing clinical features of MELAS. Fresh frozen muscle tissue was subjected to enzyme histochemical analysis. DNA was extracted from her leukocytes and muscle tissue, and the full mitochondrial genome was screened for base substitution mutations and deletions. Additionally, we screened the polymerase gamma-1 nuclear gene for mutations. The patient was negative for the most common m.3243 A>G MELAS mutation. Sequencing the full mitochondrial genome did not reveal any known or potentially pathogenic sequence changes. The polymerase gamma-1 gene was also free from mutations.</p> <p>Conclusion</p> <p>The clinical picture described here typically fits that observed in patients with MELAS or mitochondrial stroke-like events, but mutations in recognized genes (mitochondrial DNA and polymerase gamma-1 gene) were absent. We report the case of a patient with typical clinical features of MELAS, but without an obvious genetic cause.</p>