International Medical Case Reports Journal (Mar 2022)
Difficult Journey to Find the Best Treatment for Homozygous Familial Hypercholesterolemia: Case Report
Abstract
Ming-Jun Xu,1 Jian-Ping Chu,1 Wen-Ling Fei,2 Juan Wang,1 Yan-Min Zhang,3 Yi Wang1 1Department of Pediatric Intensive Medicine, Children’s Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China; 2College of Pharmaceutical, Xi’an Medical University, Xi’an, People’s Republic of China; 3Pediatric Disease Research Center of Shaanxi Province, Xi’an, People’s Republic of ChinaCorrespondence: Yi Wang, Department of Pediatric Intensive Medicine, Children’s Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China, Email [email protected]: Homozygous familial hypercholesterolemia (HoFH) is a rare autosomal recessive genetic disorder. It is difficult to diagnose and treat it at early stage. We present a nine-year-old boy with HoFH from China. At the beginning, he was misdiagnosed as xanthomatosis in the dermatology department of the local hospital, but the disease did not alleviate after three laser ablation operations. Later, blood lipid monitoring, ultrasound of heart and carotid artery were further added in our hospital, and finally the boy was diagnosed with HoFH by genetic testing. A biallelic mutations was observed in the fourth exon of low density lipoprotein receptor (LDLR): c.418G>A (p.E140K). Our patient achieved a relatively satisfactory therapeutic results after a series of lipid-lowering therapies including atorvastatin monotherapy, lipoprotein apheresis and double-filtration plasma pheresis. We found that LDL-C levels obtained 57% reduction from baseline after atorvastatin combined with double-filtration plasma pheresis (DFPP). It was observed that regression of carotid intima-media thickness (cIMT), valve regurgitation and xanthoma occurred after a series of Intensive lipid-lowering therapy.Keywords: homozygous familial hypercholesterolemia, low density lipoprotein cholesterol, double-filtration plasma pheresis
