Abstract
A 10-month-old Bahraini boy born full-term to first-degree cousins, initially had
normal developmental milestones, but presented with recurrent encephalopathy and seizures
associated with upper respiratory tract infection. With each attack, the patient developmentally
regressed further. Brain magnetic resonance imaging showed multiple old and new infarcts.
Cerebrospinal fluid biochemistry, microbiology, and amino acids were unremarkable.
Tandems mass spectrometry of urine organic acids was unremarkable as well. Electroencephalogram
showed asymmetry with cortical irritability. Whole exome sequencing revealed a homozygous
mutation of RAN-binding protein 2 gene, suggesting a diagnosis of susceptibility to
infection-induced acute encephalopathy 3, which is an autosomal dominant condition.
This is the first case to be reported in Bahrain.
Keywords
RANBP2 - susceptibility to infection-induced acute encephalopathy 3 - acute necrotizing
encephalopathy - ANE1 - RAN-binding protein 2