Skip to main content
Journal of Medical Genetics logoLink to Journal of Medical Genetics
. 1994 Jan;31(1):45–50. doi: 10.1136/jmg.31.1.45

Juvenile Kearns-Sayre syndrome initially misdiagnosed as a psychosomatic disorder.

S Nørby 1, P Lestienne 1, I Nelson 1, I M Nielsen 1, H Schmalbruch 1, O Sjö 1, M Warburg 1
PMCID: PMC1049598  PMID: 8151637

Abstract

We have investigated a 15 year old girl with progressive external ophthalmoplegia, including bilateral ptosis and retinal rod and cone cell dysfunction with atypical retinal pigmentation, complicated by cerebellar ataxia, partial cardiac conduction block, and diabetes mellitus. In infancy she had a severe crisis of bone marrow depression, and as a child she suffered from hypersensitivity to light, increasing fatigue, and vertigo, signs that were initially though to be psychosomatic. Histological examination showed mitochondrial myopathy, and subsequent mitochondrial DNA (mtDNA) analysis showed a deletion of approximately 5500 base pairs in 35 to 40% of her muscle mtDNA. We therefore conclude that this patient has developed the Kearns-Sayre syndrome after a Pearson syndrome-like crisis in her first year of life.

Full text

PDF
45

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson S., Bankier A. T., Barrell B. G., de Bruijn M. H., Coulson A. R., Drouin J., Eperon I. C., Nierlich D. P., Roe B. A., Sanger F. Sequence and organization of the human mitochondrial genome. Nature. 1981 Apr 9;290(5806):457–465. doi: 10.1038/290457a0. [DOI] [PubMed] [Google Scholar]
  2. Berenberg R. A., Pellock J. M., DiMauro S., Schotland D. L., Bonilla E., Eastwood A., Hays A., Vicale C. T., Behrens M., Chutorian A. Lumping or splitting? "Ophthalmoplegia-plus" or Kearns-Sayre syndrome? Ann Neurol. 1977 Jan;1(1):37–54. doi: 10.1002/ana.410010104. [DOI] [PubMed] [Google Scholar]
  3. Bolhuis P. A., Bleeker-Wagemakers E. M., Ponne N. J., Van Schooneveld M. J., Westerveld A., Van den Bogert C., Tabak H. F. Rapid shift in genotype of human mitochondrial DNA in a family with Leber's hereditary optic neuropathy. Biochem Biophys Res Commun. 1990 Aug 16;170(3):994–997. doi: 10.1016/0006-291x(90)90490-e. [DOI] [PubMed] [Google Scholar]
  4. Brockington M., Sweeney M. G., Hammans S. R., Morgan-Hughes J. A., Harding A. E. A tandem duplication in the D-loop of human mitochondrial DNA is associated with deletions in mitochondrial myopathies. Nat Genet. 1993 May;4(1):67–71. doi: 10.1038/ng0593-67. [DOI] [PubMed] [Google Scholar]
  5. Degoul F., Nelson I., Amselem S., Romero N., Obermaier-Kusser B., Ponsot G., Marsac C., Lestienne P. Different mechanisms inferred from sequences of human mitochondrial DNA deletions in ocular myopathies. Nucleic Acids Res. 1991 Feb 11;19(3):493–496. doi: 10.1093/nar/19.3.493. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Gerbitz K. D., Obermaier-Kusser B., Lestienne P., Zierz S., Müller-Höcker J., Pongratz D., Paetzke-Brunner I., Deufel T. Mutations of the mitochondrial DNA: the contribution of DNA techniques to the diagnosis of mitochondrial encephalomyopathies. J Clin Chem Clin Biochem. 1990 Apr;28(4):241–250. doi: 10.1515/cclm.1990.28.4.241. [DOI] [PubMed] [Google Scholar]
  7. Hammans S. R., Sweeney M. G., Holt I. J., Cooper J. M., Toscano A., Clark J. B., Morgan-Hughes J. A., Harding A. E. Evidence for intramitochondrial complementation between deleted and normal mitochondrial DNA in some patients with mitochondrial myopathy. J Neurol Sci. 1992 Jan;107(1):87–92. doi: 10.1016/0022-510x(92)90213-5. [DOI] [PubMed] [Google Scholar]
  8. Hayashi J., Ohta S., Kikuchi A., Takemitsu M., Goto Y., Nonaka I. Introduction of disease-related mitochondrial DNA deletions into HeLa cells lacking mitochondrial DNA results in mitochondrial dysfunction. Proc Natl Acad Sci U S A. 1991 Dec 1;88(23):10614–10618. doi: 10.1073/pnas.88.23.10614. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hertzberg M., Mickleson K. N., Serjeantson S. W., Prior J. F., Trent R. J. An Asian-specific 9-bp deletion of mitochondrial DNA is frequently found in Polynesians. Am J Hum Genet. 1989 Apr;44(4):504–510. [PMC free article] [PubMed] [Google Scholar]
  10. Holt I. J., Harding A. E., Morgan-Hughes J. A. Deletions of muscle mitochondrial DNA in mitochondrial myopathies: sequence analysis and possible mechanisms. Nucleic Acids Res. 1989 Jun 26;17(12):4465–4469. doi: 10.1093/nar/17.12.4465. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Holt I. J., Harding A. E., Morgan-Hughes J. A. Deletions of muscle mitochondrial DNA in patients with mitochondrial myopathies. Nature. 1988 Feb 25;331(6158):717–719. doi: 10.1038/331717a0. [DOI] [PubMed] [Google Scholar]
  12. Johns D. R., Hurko O. Preferential amplification and molecular characterization of junction sequences of a pathogenetic deletion in human mitochondrial DNA. Genomics. 1989 Oct;5(3):623–628. doi: 10.1016/0888-7543(89)90032-3. [DOI] [PubMed] [Google Scholar]
  13. KEARNS T. P., SAYRE G. P. Retinitis pigmentosa, external ophthalmophegia, and complete heart block: unusual syndrome with histologic study in one of two cases. AMA Arch Ophthalmol. 1958 Aug;60(2):280–289. [PubMed] [Google Scholar]
  14. Larsson N. G., Holme E., Kristiansson B., Oldfors A., Tulinius M. Progressive increase of the mutated mitochondrial DNA fraction in Kearns-Sayre syndrome. Pediatr Res. 1990 Aug;28(2):131–136. doi: 10.1203/00006450-199008000-00011. [DOI] [PubMed] [Google Scholar]
  15. Lestienne P. Mitochondrial DNA mutations in human diseases: a review. Biochimie. 1992 Feb;74(2):123–130. doi: 10.1016/0300-9084(92)90035-d. [DOI] [PubMed] [Google Scholar]
  16. Lestienne P. Mitochondrial and nuclear DNA complementation in the respiratory chain function and defects. Biochimie. 1989 Nov-Dec;71(11-12):1115–1123. doi: 10.1016/0300-9084(89)90015-1. [DOI] [PubMed] [Google Scholar]
  17. Lestienne P., Ponsot G. Kearns-Sayre syndrome with muscle mitochondrial DNA deletion. Lancet. 1988 Apr 16;1(8590):885–885. doi: 10.1016/s0140-6736(88)91632-7. [DOI] [PubMed] [Google Scholar]
  18. Lott M. T., Voljavec A. S., Wallace D. C. Variable genotype of Leber's hereditary optic neuropathy patients. Am J Ophthalmol. 1990 Jun 15;109(6):625–631. doi: 10.1016/s0002-9394(14)72429-8. [DOI] [PubMed] [Google Scholar]
  19. McShane M. A., Hammans S. R., Sweeney M., Holt I. J., Beattie T. J., Brett E. M., Harding A. E. Pearson syndrome and mitochondrial encephalomyopathy in a patient with a deletion of mtDNA. Am J Hum Genet. 1991 Jan;48(1):39–42. [PMC free article] [PubMed] [Google Scholar]
  20. Mita S., Rizzuto R., Moraes C. T., Shanske S., Arnaudo E., Fabrizi G. M., Koga Y., DiMauro S., Schon E. A. Recombination via flanking direct repeats is a major cause of large-scale deletions of human mitochondrial DNA. Nucleic Acids Res. 1990 Feb 11;18(3):561–567. doi: 10.1093/nar/18.3.561. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Moraes C. T., DiMauro S., Zeviani M., Lombes A., Shanske S., Miranda A. F., Nakase H., Bonilla E., Werneck L. C., Servidei S. Mitochondrial DNA deletions in progressive external ophthalmoplegia and Kearns-Sayre syndrome. N Engl J Med. 1989 May 18;320(20):1293–1299. doi: 10.1056/NEJM198905183202001. [DOI] [PubMed] [Google Scholar]
  22. Mullie M. A., Harding A. E., Petty R. K., Ikeda H., Morgan-Hughes J. A., Sanders M. D. The retinal manifestations of mitochondrial myopathy. A study of 22 cases. Arch Ophthalmol. 1985 Dec;103(12):1825–1830. doi: 10.1001/archopht.1985.01050120059020. [DOI] [PubMed] [Google Scholar]
  23. Nakase H., Moraes C. T., Rizzuto R., Lombes A., DiMauro S., Schon E. A. Transcription and translation of deleted mitochondrial genomes in Kearns-Sayre syndrome: implications for pathogenesis. Am J Hum Genet. 1990 Mar;46(3):418–427. [PMC free article] [PubMed] [Google Scholar]
  24. Nelson I., Bonne G., Degoul F., Marsac C., Ponsot G., Lestienne P. Kearns-Sayre syndrome with sideroblastic anemia: molecular investigations. Neuropediatrics. 1992 Aug;23(4):199–205. doi: 10.1055/s-2008-1071341. [DOI] [PubMed] [Google Scholar]
  25. Nelson I., Degoul F., Obermaier-Kusser B., Romero N., Borrone C., Marsac C., Vayssiere J. L., Gerbitz K., Fardeau M., Ponsot G. Mapping of heteroplasmic mitochondrial DNA deletions in Kearns-Sayre syndrome. Nucleic Acids Res. 1989 Oct 25;17(20):8117–8124. doi: 10.1093/nar/17.20.8117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Nørby S., Lestienne P., Nelson I., Rosenberg T. Mutation detection in Leber's hereditary optic neuropathy by PCR with allele-specific priming. Biochem Biophys Res Commun. 1991 Mar 15;175(2):631–636. doi: 10.1016/0006-291x(91)91612-g. [DOI] [PubMed] [Google Scholar]
  27. Pearson H. A., Lobel J. S., Kocoshis S. A., Naiman J. L., Windmiller J., Lammi A. T., Hoffman R., Marsh J. C. A new syndrome of refractory sideroblastic anemia with vacuolization of marrow precursors and exocrine pancreatic dysfunction. J Pediatr. 1979 Dec;95(6):976–984. doi: 10.1016/s0022-3476(79)80286-3. [DOI] [PubMed] [Google Scholar]
  28. Rötig A., Colonna M., Blanche S., Fischer A., Le Deist F., Frezal J., Saudubray J. M., Munnich A. Deletion of blood mitochondrial DNA in pancytopenia. Lancet. 1988 Sep 3;2(8610):567–568. doi: 10.1016/s0140-6736(88)92687-6. [DOI] [PubMed] [Google Scholar]
  29. Rötig A., Cormier V., Koll F., Mize C. E., Saudubray J. M., Veerman A., Pearson H. A., Munnich A. Site-specific deletions of the mitochondrial genome in the Pearson marrow-pancreas syndrome. Genomics. 1991 Jun;10(2):502–504. doi: 10.1016/0888-7543(91)90342-c. [DOI] [PubMed] [Google Scholar]
  30. Schon E. A., Rizzuto R., Moraes C. T., Nakase H., Zeviani M., DiMauro S. A direct repeat is a hotspot for large-scale deletion of human mitochondrial DNA. Science. 1989 Apr 21;244(4902):346–349. doi: 10.1126/science.2711184. [DOI] [PubMed] [Google Scholar]
  31. Shanske S., Moraes C. T., Lombes A., Miranda A. F., Bonilla E., Lewis P., Whelan M. A., Ellsworth C. A., DiMauro S. Widespread tissue distribution of mitochondrial DNA deletions in Kearns-Sayre syndrome. Neurology. 1990 Jan;40(1):24–28. doi: 10.1212/wnl.40.1.24. [DOI] [PubMed] [Google Scholar]
  32. Shoffner J. M., Lott M. T., Voljavec A. S., Soueidan S. A., Costigan D. A., Wallace D. C. Spontaneous Kearns-Sayre/chronic external ophthalmoplegia plus syndrome associated with a mitochondrial DNA deletion: a slip-replication model and metabolic therapy. Proc Natl Acad Sci U S A. 1989 Oct;86(20):7952–7956. doi: 10.1073/pnas.86.20.7952. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Vilkki J., Savontaus M. L., Nikoskelainen E. K. Segregation of mitochondrial genomes in a heteroplasmic lineage with Leber hereditary optic neuroretinopathy. Am J Hum Genet. 1990 Jul;47(1):95–100. [PMC free article] [PubMed] [Google Scholar]
  34. Wallace D. C. Diseases of the mitochondrial DNA. Annu Rev Biochem. 1992;61:1175–1212. doi: 10.1146/annurev.bi.61.070192.005523. [DOI] [PubMed] [Google Scholar]
  35. Zeviani M., Gellera C., Pannacci M., Uziel G., Prelle A., Servidei S., DiDonato S. Tissue distribution and transmission of mitochondrial DNA deletions in mitochondrial myopathies. Ann Neurol. 1990 Jul;28(1):94–97. doi: 10.1002/ana.410280118. [DOI] [PubMed] [Google Scholar]
  36. Zeviani M., Moraes C. T., DiMauro S., Nakase H., Bonilla E., Schon E. A., Rowland L. P. Deletions of mitochondrial DNA in Kearns-Sayre syndrome. Neurology. 1988 Sep;38(9):1339–1346. doi: 10.1212/wnl.38.9.1339. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Medical Genetics are provided here courtesy of BMJ Publishing Group

RESOURCES