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Kleine-Levin syndrome with comorbid iron deficiency anemia.

Jain RS, Kumar S, Srivastava T, Sannegowda RB - Oxf Med Case Reports (2015)

Bottom Line: During episodes, the patient used to sleep as long as 20 h in a day, affecting his daily living activities.The treatment of IDA along with modafinil decreased the severity of symptoms and shortened the hospital stay during episodes.This might be the first case report of KLS with comorbid IDA.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurology , Sawai Man Singh Medical College , Jaipur, Rajasthan , India.

ABSTRACT
Kleine-Levin syndrome (KLS) is a rare chronic sleep disorder of unknown etiopathology, which typically occurs in adolescent males. Although the severity of symptoms and disease course varies between the KLS patients, it usually resolves spontaneously, but sometime comorbid conditions may worsen the symptoms. Herein, we report a case of KLS who presented with severe episodic hypersomnia. During episodes, the patient used to sleep as long as 20 h in a day, affecting his daily living activities. All the relevant investigations including electroencephalography, magnetic resonance imaging of brain and cerebrospinal fluid analysis were normal except for severe iron deficiency anemia (IDA). In our patient, the severity of symptoms worsened due to coexistent IDA. The treatment of IDA along with modafinil decreased the severity of symptoms and shortened the hospital stay during episodes. This might be the first case report of KLS with comorbid IDA.

No MeSH data available.


Related in: MedlinePlus

Magnetic resonance imaging of brain showing normal study (a and b).
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OMV019F1: Magnetic resonance imaging of brain showing normal study (a and b).

Mentions: Six-month back patient was hospitalized with similar complaints. His hemogram revealed severe microcytic-hypochromic anemia (hemoglobin; 6.3 mg/dl), without any evidence of hemolysis or hemoglobinopathies. Osmotic fragility testing was negative. The mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular volume (MCV) were 18 g/dl (32–36 g/dl) and 65 fl (83–97 fl), respectively. The serum iron was 32 µg/dl (60–170 µg/dl), ferritin 6 ng/ml (12–300 ng/ml) and total iron binding capacity (TIBC) 360 µg/dl (240–450 µg/dl). Bone marrow aspiration cytology showed evidence of microcytic-hypochromic anemia without stainable iron in tissue. Stool examination was negative for occult blood, ova and cyst. Serum biochemistry including thyroid function tests and serum vitamin B12 levels were normal. Abdominal ultrasonography, upper and lower gastrointestinal endoscopy were normal. Electroencephalography and gadolinium-enhanced magnetic resonance imaging (MRI) of brain were normal (Fig. 1a and b). Epworth sleepiness scale (ESS) score during hypersomnic episode and asymptomatic period were 20 and 6 (out of possible 24 points), respectively. The polysomnography (PSG) study was done after blood transfusion near the end of episode. The recordings included electrocardiogram, pneumogram, nasal and buccal thermistors, submental and tibialis anterior surface electromyography, electrooculography, electroencephalography (EEG) and transcutaneous pulse oximeter finger probe for oxygen saturation. The PSG study during asymptomatic period was normal. Overnight PSG recordings during hypersomnic episode showed sleep onset latency and mean sleep latency of multiple sleep latency testing (MSLT) were 9.5 and 8 min, respectively, with normal sleep architecture without evidence of breathing or heart rate dysfunction, narcolepsy, obstructive sleep apnea or periodic limb movements. During sleep, the technician faced difficulty to wake up the patient because of severe drive to sleep.Figure 1:


Kleine-Levin syndrome with comorbid iron deficiency anemia.

Jain RS, Kumar S, Srivastava T, Sannegowda RB - Oxf Med Case Reports (2015)

Magnetic resonance imaging of brain showing normal study (a and b).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664840&req=5

OMV019F1: Magnetic resonance imaging of brain showing normal study (a and b).
Mentions: Six-month back patient was hospitalized with similar complaints. His hemogram revealed severe microcytic-hypochromic anemia (hemoglobin; 6.3 mg/dl), without any evidence of hemolysis or hemoglobinopathies. Osmotic fragility testing was negative. The mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular volume (MCV) were 18 g/dl (32–36 g/dl) and 65 fl (83–97 fl), respectively. The serum iron was 32 µg/dl (60–170 µg/dl), ferritin 6 ng/ml (12–300 ng/ml) and total iron binding capacity (TIBC) 360 µg/dl (240–450 µg/dl). Bone marrow aspiration cytology showed evidence of microcytic-hypochromic anemia without stainable iron in tissue. Stool examination was negative for occult blood, ova and cyst. Serum biochemistry including thyroid function tests and serum vitamin B12 levels were normal. Abdominal ultrasonography, upper and lower gastrointestinal endoscopy were normal. Electroencephalography and gadolinium-enhanced magnetic resonance imaging (MRI) of brain were normal (Fig. 1a and b). Epworth sleepiness scale (ESS) score during hypersomnic episode and asymptomatic period were 20 and 6 (out of possible 24 points), respectively. The polysomnography (PSG) study was done after blood transfusion near the end of episode. The recordings included electrocardiogram, pneumogram, nasal and buccal thermistors, submental and tibialis anterior surface electromyography, electrooculography, electroencephalography (EEG) and transcutaneous pulse oximeter finger probe for oxygen saturation. The PSG study during asymptomatic period was normal. Overnight PSG recordings during hypersomnic episode showed sleep onset latency and mean sleep latency of multiple sleep latency testing (MSLT) were 9.5 and 8 min, respectively, with normal sleep architecture without evidence of breathing or heart rate dysfunction, narcolepsy, obstructive sleep apnea or periodic limb movements. During sleep, the technician faced difficulty to wake up the patient because of severe drive to sleep.Figure 1:

Bottom Line: During episodes, the patient used to sleep as long as 20 h in a day, affecting his daily living activities.The treatment of IDA along with modafinil decreased the severity of symptoms and shortened the hospital stay during episodes.This might be the first case report of KLS with comorbid IDA.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurology , Sawai Man Singh Medical College , Jaipur, Rajasthan , India.

ABSTRACT
Kleine-Levin syndrome (KLS) is a rare chronic sleep disorder of unknown etiopathology, which typically occurs in adolescent males. Although the severity of symptoms and disease course varies between the KLS patients, it usually resolves spontaneously, but sometime comorbid conditions may worsen the symptoms. Herein, we report a case of KLS who presented with severe episodic hypersomnia. During episodes, the patient used to sleep as long as 20 h in a day, affecting his daily living activities. All the relevant investigations including electroencephalography, magnetic resonance imaging of brain and cerebrospinal fluid analysis were normal except for severe iron deficiency anemia (IDA). In our patient, the severity of symptoms worsened due to coexistent IDA. The treatment of IDA along with modafinil decreased the severity of symptoms and shortened the hospital stay during episodes. This might be the first case report of KLS with comorbid IDA.

No MeSH data available.


Related in: MedlinePlus