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LETTER TO EDITOR
Year : 2016  |  Volume : 16  |  Issue : 1  |  Page : 89

Synovial chondromatosis of the knee joint in infant: A case report and literature review


Department of Paediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq

Date of Web Publication7-Jan-2016

Correspondence Address:
Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-6308.173475

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How to cite this article:
Al-Mendalawi MD. Synovial chondromatosis of the knee joint in infant: A case report and literature review. Saudi J Sports Med 2016;16:89

How to cite this URL:
Al-Mendalawi MD. Synovial chondromatosis of the knee joint in infant: A case report and literature review. Saudi J Sports Med [serial online] 2016 [cited 2023 Feb 8];16:89. Available from: https://www.sjosm.org/text.asp?2016/16/1/89/173475

Sir,

With reference to the case report by Al-Khawashki,[1] chondromatosis (CM) tends to occur in the older age group. The case in questions is really interesting as the author addressed CM in the youngest pediatric patient (16-month-old boy) reported in the literature.[1] However, the author did not attempt to disclose the vulnerability of CM to occur in such a young patient. I presume that the following point might plausibly explain it. It is obvious that hydroxyglutaric aciduria (HGAU) is a rare and novel autosomal recessive inherited neurometabolic disorder. It is characterized by the accumulation of abnormal amounts of D-2-hydroxyglutaric acid (D-2-HGA) in cerebrospinal fluid, blood, and urine. The clinical phenotype varies widely from neonatal severe epileptic encephalopathy to asymptomatic. Magnetic resonance imaging of the affected patients show the typical signs of delayed cerebral maturation, ventricular abnormalities, and the presence of sub-ependymal cysts in the earlier months of life.[2] A distinct entity of an unusual combination of characteristic skeletal CM and metabolic abnormalities of HGAU has been addressed. Choo et al. have reported four patients who presented with a severe form of metaphyseal CM in an association with HGAU. Although D-2-HGA was excreted in high amounts in the urine of all the four studied patients, no significant neurologic abnormalities were evident. Accordingly, Choo et al. suggested that a urine organic acid screening can be obtained in the patients who present with CM.[3] Though the case in question was apparently healthy with no neurological deficits as addressed by Al-Khawashki,[1] this does not provisionally exclude HGAU. This is because the disease might run an asymptomatic course.[2],[3] In the light of prevailing consanguineous marriage in Kingdom of Saudi Arabia [4] and the significant association of consanguinity with the various types of inborn errors of the metabolism, including HGAU,[5] I presume that HGAU ought to be considered in the case in question. If that was proved by suitable diagnostic algorithm of neuroimaging study, measurement of D-2-HGA in body fluids and mutational analysis, the case in question could be confidently added to the literature as a novel case report of HGAU-associated CM in the youngest pediatric patient.

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  References Top

1.
Al-Khawashki H. Synovial chondromatosis of the knee joint in infant: A case report and literature review. Saudi J Sports Med 2015;15:204-6.  Back to cited text no. 1
  Medknow Journal  
2.
Mahfoud A, Domínguez CL, Rashed M, Durán M, Rodríguez T, Rodríguez D, et al. D-2-hydroxyglutaric aciduria. Report of two cases. Invest Clin 2009;50:369-75.  Back to cited text no. 2
    
3.
Choo HJ, Cho TJ, Song J, Tiller GE, Lee SH, Park G, et al. Metaphyseal chondromatosis combined with D-2-hydroxyglutaric aciduria in four patients. Skeletal Radiol 2012;41:1479-87.  Back to cited text no. 3
    
4.
Warsy AS, Al-Jaser MH, Albdass A, Al-Daihan S, Alanazi M. Is consanguinity prevalence decreasing in Saudis? A study in two generations. Afr Health Sci 2014;14:314-21.  Back to cited text no. 4
    
5.
Al Bu Ali WH, Balaha MH, Al Moghannum MS, Hashim I. Risk factors and birth prevalence of birth defects and inborn errors of metabolism in Al Ahsa, Saudi Arabia. Pan Afr Med J 2011;8:14.  Back to cited text no. 5
    




 

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