Painful micturition in a small child: an unusual clinical picture of paroxysmal extreme pain disorder

• Published in: Pediatric nephrology (Berlin, West) West), 2014-09, Vol.29 (9), p.1643-1646
• Main Authors: Meglič, Anamarija, Perkovič-Benedik, Mirjana, Trebušak Podkrajšek, Katarina, Bertok, Sara
• Format: Article
• Language: English
• Subjects: Analgesics, Non-Narcotic - therapeutic use; Base Sequence; Brief Report; Carbamazepine - therapeutic use; Care and treatment; Case studies; Child, Preschool; Children & youth; Complications and side effects; Female; Gene mutations; Girls; Hospitals; Humans; Medicine; Medicine & Public Health; Molecular Sequence Data; Motor ability; Mutation; Mutation, Missense; NAV1.7 Voltage-Gated Sodium Channel - genetics; Nephrology; Pain; Pain - complications; Pain - genetics; Patient outcomes; Pediatrics; Pedigree; Rectum - abnormalities; Risk factors; Sodium; Sodium channels; Somatoform disorders; Urination; Urination Disorders - drug therapy; Urination Disorders - genetics; Urogenital system; Urology
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-014-2819-2

Background Paroxysmal extreme pain disorder (PEPD) is a rare autosomal dominant pain disorder linked to a mutation in the SCN9A gene, which encodes voltage-gated sodium channel Nav1.7. Abnormal pain sensitivity occurs because of changes in the properties of voltage-gated sodium channels. Different mutations in SCN9A and a spectrum of clinical expressions have been described. Case-Diagnosis/Treatment Here we describe a 3-year-old child with a rare clinical picture of PEPD. Extremely painful voiding had been present since the child’s birth. The diagnosis was confirmed by the detection of a heterozygous pathogenic mutation in the SCN9A gene, c.554G>A (p.Arg185His) inherited paternally. The same mutation was also found in the girl’s father, who has occasionally had some pain in his jaw while yawning since childhood. Significant reduction of the pain was achieved with carbamazepine. Conclusions The case is interesting because the same mutation as that found in the girl and her father has been found in patients with small fiber sensory neuropathy. These data do not correlate with the clinical picture of our case and her father, but intra- and interfamily phenotypic diversity in symptoms associated with a gain-of-function variant of Na(V)1.7 are also described and may explain our case.