A novel CYP27A1 frameshift mutation causing cerebrotendinous xanthomatosis in an Indian family

Abstract

Cerebrotendinous xanthomatosis is a rare and underreported lipid storage disorder caused by various mutations in the CYP27A1 gene. Here, we report a novel homozygous mutation in the CYP27A1 gene in an Indian family. A 30-year-old man presented with childhood cataracts in both eyes; recurrent, intractable watery diarrhea; progressive cognitive impairment; bilateral patellar and Achilles tendon xanthomas; and ataxic speech and gait. Out of five siblings, four had similar symptoms. Three of the patient's siblings had the same novel mutation in the CYP27A1 gene on the chromosome 2 region with c.301delG (Pro102LeufsTer5 protein change), which was homozygous. To date, the variant status of this mutation has not been reported in the Human Gene Mutation Database, the Exome Aggregation Consortium, and 1000 Genomes Project. Despite the clinical confirmation of the diagnosis and molecular analysis, our patient's symptoms did not improve with treatment for more than a year, because of delayed presentation with irreversible damage. Treatment with chenodeoxycholic acid and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors can reduce or reverse the progression of the disease; however, early diagnosis is key.