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Deborah Marsden, MBBS, MRCP; Karin Sege-Petersen, MD, PhD; William L. Nyhan, MD, PhD; Wulf Roeschinger, MD; Lawrence Sweetman, PhD

Am J Dis Child. 1992;146(12):1459-1462.

Abstract
• Objective.
—To report an atypical presentation of medium-chain acyl Coenzyme A dehydrogenase deficiency in a 13-year-old girl with hyperammonemic encephalopathy and orotic aciduria meeting the accepted criteria for diagnosis of a female heterozygous for ornithine transcarbamylase deficiency.

Design.
—Case report and definitive biochemical testing.

Setting.
—Children's hospital and university laboratory.

Participant.
—One teenager.

Interventions.
—Diagnosis and treatment with carnitine.

Measurements/Main Results.
—Assay ornithine transcarbamylase deficiency had normal results. The diagnosis was confirmed by DNA analysis, which revealed homozygosity for prevalent mutation (the adenine to guanine transition at position 985).

Conclusions.
—Patients with a clinical diagnosis of Reye's syndrome have, in general, an inborn error of metabolism. Medium-chain acyl Coenzyme A dehydrogenase deficiency and other disorders of fatty acid oxidation may present long after infancy. They may mimic the presentation of defects in the urea cycle.

(AJDC. 1992;146:1459-1462)

Author Affiliations
From the Department of Pediatrics (Drs Marsden, Sege-Petersen, and Nyhan) and the Institute of Molecular Genetics (Dr Nyhan), University of California-San Diego, La Jolla, and the Biochemical Genetics Laboratory, Children's Hospital of Los Angeles (Calif) (Drs Roeschinger and Sweetman).

Footnotes
Accepted for publication August 4, 1992.

Reprint requests to Department of Pediatrics (0609A), University of California-San Diego, School of Medicine, 9500 Gilman Dr, La Jolla, CA 92093-0609 (Dr Nyhan).

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