Modern Pediatrics. Ukraine. (2022). 3(123): 85-93. doi 10.15574/SP.2022.123.85
Dorosh O. I.^1,2, Dushar M. I.³, Masynnyk Yu. S.⁴, Stegnitskaya M. V.^1
1СNE of Lviv regional council «Western Ukrainian Specialized Pediatric Medical Centre», Ukraine
²Danylo Halytsky Lviv National Medical University, Ukraine
³SI «Institute of Hereditary Pathology of the NAMS of Ukraine», Lviv
⁴Center for Medical Innovations NOVO, Lviv, Ukraine

For citation: Dorosh OI, Dushar MI, Masynnyk YuS, Stegnitskaya MV. (2022). Tyrosinemia type 1 in a child, experience of a hematologist. Clinical case. Modern Pediatrics. Ukraine. 3(123): 85-93. doi 10.15574/SP.2022.123.85.
Article received: Jan 28, 2022. Accepted for publication: Apr 19, 2022.

Tyrosinemia is a rare metabolic disease resulting from a metabolic disorder of amino acids, which can occur under the «masks» of various diseases, debut as a hemorrhagic syndrome in children of all age groups, hepatolienal syndrome, hypoglycemia, rickets-like disease, peripheral neuropathy.
Clinical case. In our publication, we report on a girl at the age of 1 year 7 months who had recurrent nosebleeds, which led to a referral to a hematologist. Examination revealed hepatomegaly with impaired liver function (hypoproteinemia, long-term resistant hypoglycemia, coagulopathy) with the development of chronic liver failure, ascites and splenomegaly with signs of hypersplenism, ascites, and nephromegaly. Differential diagnostics was carried out between oncohematological process, myelodysplastic syndrome (MDS) and metabolic disease. Type 1 tyrosinemia (hereditary infantile tyrosinemia (HT-1)) was verified by a combination of clinical and biochemical, molecular genetic studies. Verification of the disease came from the spectrometry of amino acids, acylcarnitines, succinal acetates and molecular genetic studies. Molecular genetic studies in the INVITAE laboratory, USA revealed two pathogenic variants identified in the FAH gene c.1069G>T (p.Glu357*) and c.554-1G>T, which are associated with autosomal recessive tyrosinemia. The emphasis in the publication is on the differential diagnosis, the effectiveness of the treatment of this orphan disease. The method of pathogenetic therapy of HT-1 is described in detail, both with the use of the drug nitisinone (orphadin) registered in Ukraine, a special diet with a low content of phenylalanine / tyrosine, which have a pronounced positive clinical effect and prevent the formation of irreversible disabling disorders. We emphasize the need for early diagnosis of HT-1 and support the Ministry of Health of Ukraine in the initiative of routine neonatal screening for orphan diseases, which include HT-1, since timely treatment improves the quality of life in these patients.
The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
Key words: hepatosplenomegaly, nephromegaly, tyrosinemia type 1, children.
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