Skip to main content
Erschienen in: Forensic Science, Medicine and Pathology 4/2017

04.11.2017 | Case Report

Sudden death due to malignant hyperthermia with a mutation of RYR1: autopsy, morphology and genetic analysis

verfasst von: Wenhe Li, Lin Zhang, Yue Liang, Fang Tong, Yiwu Zhou

Erschienen in: Forensic Science, Medicine and Pathology | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Abstract

Malignant hyperthermia (MH) is an autosomal dominant disorder characterized by abnormal calcium homeostasis in skeletal muscles in response to triggering agents. Autopsy, morphology, and genetic analysis were performed on a 19-year-old man who died rapidly after exposure to sevoflurane during maxillofacial surgery. Muscle spasm around the operation area and limb rigidity occurred and renal tubules full of myoglobin casts were observed by microscopy. Ultrastructural changes in the skeletal muscles and the myocardium were detected by transmission electron microscopy (TEM). Genetic analysis disclosed a ryanodine receptor type 1 (RYR1) gene mutation and a nucleoide mutation in chromosome 19q (G1021A) in the deceased and his father. According to the fore mentioned results, the relationship between the cause of death and MH was confirmed. Thus, genetic analysis can be an important procedure in diagnosing MH.
Literatur
1.
Zurück zum Zitat Denborough MA, Forster JF, Lovell RR, Maplestone PA, Villiers JD. Anaesthetic deaths in a family. Br J Anaesth. 1962;34:395.CrossRefPubMed Denborough MA, Forster JF, Lovell RR, Maplestone PA, Villiers JD. Anaesthetic deaths in a family. Br J Anaesth. 1962;34:395.CrossRefPubMed
2.
Zurück zum Zitat Larach MG, Brandom BW, Allen GC, Gronert GA, Lehman EB. Malignant hyperthermia deaths related to inadequate temperature monitoring, 2007-2012: a report from the North American malignant hyperthermia registry of the malignant hyperthermia association of the United States. Anesth Analg. 2014;119:1359–66.CrossRefPubMed Larach MG, Brandom BW, Allen GC, Gronert GA, Lehman EB. Malignant hyperthermia deaths related to inadequate temperature monitoring, 2007-2012: a report from the North American malignant hyperthermia registry of the malignant hyperthermia association of the United States. Anesth Analg. 2014;119:1359–66.CrossRefPubMed
3.
Zurück zum Zitat Girard T, Urwyler A, Censier K, Mueller CR, Zorzato F, Treves S. Genotype-phenotype comparison of the Swiss malignant hyperthermia population. Hum Mutat. 2001;18:357–8.CrossRefPubMed Girard T, Urwyler A, Censier K, Mueller CR, Zorzato F, Treves S. Genotype-phenotype comparison of the Swiss malignant hyperthermia population. Hum Mutat. 2001;18:357–8.CrossRefPubMed
4.
Zurück zum Zitat Karger B, Teige K. Fatal malignant hyperthermia—delayed onset and atypical course. Forensic Sci Int. 2002;129:187–90.CrossRefPubMed Karger B, Teige K. Fatal malignant hyperthermia—delayed onset and atypical course. Forensic Sci Int. 2002;129:187–90.CrossRefPubMed
5.
Zurück zum Zitat Nishio H, Sato T, Fukunishi S, Tamura A, Iwata M, Tsuboi K, et al. Identification of malignant hyperthermia-susceptible ryanodine receptor type 1 gene (RYR1) mutations in a child who died in a car after exposure to a high environmental temperature. Legal Med. 2009;11:142–3.CrossRefPubMed Nishio H, Sato T, Fukunishi S, Tamura A, Iwata M, Tsuboi K, et al. Identification of malignant hyperthermia-susceptible ryanodine receptor type 1 gene (RYR1) mutations in a child who died in a car after exposure to a high environmental temperature. Legal Med. 2009;11:142–3.CrossRefPubMed
6.
Zurück zum Zitat Migita T, Mukaida K, Kobayashi M, Hamada H, Kawamoto M. The severity of sevoflurane-induced malignant hyperthermia. Acta Anaesthesiol Scand. 2012;56:351–6.CrossRefPubMed Migita T, Mukaida K, Kobayashi M, Hamada H, Kawamoto M. The severity of sevoflurane-induced malignant hyperthermia. Acta Anaesthesiol Scand. 2012;56:351–6.CrossRefPubMed
7.
Zurück zum Zitat Chamley D, Pollock NA, Stowell KM, Brown RL. Malignant hyperthermia in infancy and identification of novel RYR1 mutation. Br J Anaesth. 2000;84:500–4.CrossRefPubMed Chamley D, Pollock NA, Stowell KM, Brown RL. Malignant hyperthermia in infancy and identification of novel RYR1 mutation. Br J Anaesth. 2000;84:500–4.CrossRefPubMed
9.
Zurück zum Zitat Mickelson JR, Gallant EM, Litterer LA, Johnson KM, Rempel WE, Louis CF. Abnormal sarcoplasmic reticulum ryanodine receptor in malignant hyperthermia. J Biol Chem. 1988;263:9310–5.PubMed Mickelson JR, Gallant EM, Litterer LA, Johnson KM, Rempel WE, Louis CF. Abnormal sarcoplasmic reticulum ryanodine receptor in malignant hyperthermia. J Biol Chem. 1988;263:9310–5.PubMed
10.
Zurück zum Zitat Schuster F, Johannsen S, Roewer N, et al. A minimal-invasive metabolic test detects malignant hyperthermia susceptibility in a patient after sevoflurane-induced metabolic crisis. Case Rep Anesthesiol 2013;872310. https://doi.org/10.1155/2013/953859. Schuster F, Johannsen S, Roewer N, et al. A minimal-invasive metabolic test detects malignant hyperthermia susceptibility in a patient after sevoflurane-induced metabolic crisis. Case Rep Anesthesiol 2013;872310. https://​doi.​org/​10.​1155/​2013/​953859.
11.
Zurück zum Zitat Fill M, Coronado R, Mickelson JR, Vilven J, Ma JJ, Jacobson BA, et al. Abnormal ryanodine receptor channels in malignant hyperthermia. Biophys J. 1990;57:471–5.CrossRefPubMedPubMedCentral Fill M, Coronado R, Mickelson JR, Vilven J, Ma JJ, Jacobson BA, et al. Abnormal ryanodine receptor channels in malignant hyperthermia. Biophys J. 1990;57:471–5.CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Rosenberg H, Fletcher J. An update on the malignant hyperthermia syndrome. Ann Acad Med Singap. 1994;23:84–97.PubMed Rosenberg H, Fletcher J. An update on the malignant hyperthermia syndrome. Ann Acad Med Singap. 1994;23:84–97.PubMed
13.
Zurück zum Zitat Jurkat-Rott K, McCarthy T, Lehmann-Horn F. Genetics and pathogenesis of malignant hyperthermia. Muscle Nerve. 2000;23:4–17.CrossRefPubMed Jurkat-Rott K, McCarthy T, Lehmann-Horn F. Genetics and pathogenesis of malignant hyperthermia. Muscle Nerve. 2000;23:4–17.CrossRefPubMed
14.
Zurück zum Zitat Krause T, Gerbershagen M, Fiege M, Weisshorn R, Wappler F. Dantrolene–a review of its pharmacology, therapeutic use and new developments. Anaesthesia. 2004;59:364–73.CrossRefPubMed Krause T, Gerbershagen M, Fiege M, Weisshorn R, Wappler F. Dantrolene–a review of its pharmacology, therapeutic use and new developments. Anaesthesia. 2004;59:364–73.CrossRefPubMed
15.
Zurück zum Zitat Christiansen LR, Collins KA. Pathologic findings in malignant hyperthermia: a case report and review of literature. Am J Forensic Med Pathol. 2004;25:327–33.CrossRefPubMed Christiansen LR, Collins KA. Pathologic findings in malignant hyperthermia: a case report and review of literature. Am J Forensic Med Pathol. 2004;25:327–33.CrossRefPubMed
16.
Zurück zum Zitat Mezin P, Payen J, Bosson J, Brambilla E, Stieglitz P. Histological support for the difference between malignant hyperthermia susceptible (MHS), equivocal (MHE) and negative (MHN) muscle biopsies. Br J Anaesth. 1997;79:327–31.CrossRefPubMed Mezin P, Payen J, Bosson J, Brambilla E, Stieglitz P. Histological support for the difference between malignant hyperthermia susceptible (MHS), equivocal (MHE) and negative (MHN) muscle biopsies. Br J Anaesth. 1997;79:327–31.CrossRefPubMed
17.
Zurück zum Zitat Larach MG, Gronert GA, Allen GC, Brandom BW, Lehman EB. Clinical presentation, treatment, and complications of malignant hyperthermia in North America from 1987 to 2006. Anesth Analg. 2010;110:498–507.CrossRefPubMed Larach MG, Gronert GA, Allen GC, Brandom BW, Lehman EB. Clinical presentation, treatment, and complications of malignant hyperthermia in North America from 1987 to 2006. Anesth Analg. 2010;110:498–507.CrossRefPubMed
18.
Zurück zum Zitat Palmiere C, Mangin P. Hyperthermia and postmortem biochemical investigations. Int J Legal Med. 2013;127:93–102.CrossRefPubMed Palmiere C, Mangin P. Hyperthermia and postmortem biochemical investigations. Int J Legal Med. 2013;127:93–102.CrossRefPubMed
21.
Zurück zum Zitat Robinson R, Curran J, Hall W, Halsall P, Hopkins P, Markham A, et al. Genetic heterogeneity and HOMOG analysis in British malignant hyperthermia families. J Med Genet. 1998;35:196–201.CrossRefPubMedPubMedCentral Robinson R, Curran J, Hall W, Halsall P, Hopkins P, Markham A, et al. Genetic heterogeneity and HOMOG analysis in British malignant hyperthermia families. J Med Genet. 1998;35:196–201.CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Phillips MS, Fujii J, Khanna VK, DeLeon S, Yokobata K, de Jong PJ, et al. The structural organization of the human skeletal muscle ryanodine receptor (RYR1) gene. Genomics. 1996;34:24–41.CrossRefPubMed Phillips MS, Fujii J, Khanna VK, DeLeon S, Yokobata K, de Jong PJ, et al. The structural organization of the human skeletal muscle ryanodine receptor (RYR1) gene. Genomics. 1996;34:24–41.CrossRefPubMed
23.
Zurück zum Zitat Robinson RL, Brooks C, Brown SL, Ellis FR, Halsall PJ, Quinnell RJ, et al. RYR1 mutations causing central core disease are associated with more severe malignant hyperthermia in vitro contracture test phenotypes. Hum Mutat. 2002;20:88–97.CrossRefPubMed Robinson RL, Brooks C, Brown SL, Ellis FR, Halsall PJ, Quinnell RJ, et al. RYR1 mutations causing central core disease are associated with more severe malignant hyperthermia in vitro contracture test phenotypes. Hum Mutat. 2002;20:88–97.CrossRefPubMed
24.
Zurück zum Zitat Quane KA, Keating KE, Healy JS, Manning BM, Krivosic-Horber R, Krivosic I, et al. Mutation screening of the RYR1 gene in malignant hyperthermia: detection of a novel Tyr to Ser mutation in a pedigree with associated central cores. Genomics. 1994;23:236–9.CrossRefPubMed Quane KA, Keating KE, Healy JS, Manning BM, Krivosic-Horber R, Krivosic I, et al. Mutation screening of the RYR1 gene in malignant hyperthermia: detection of a novel Tyr to Ser mutation in a pedigree with associated central cores. Genomics. 1994;23:236–9.CrossRefPubMed
25.
Zurück zum Zitat Fagerlund T, Ording H, Bendixen D, et al. RYR mutation G1021A (Gly341Arg) is not frequent in Danish and Swedish families with malignant hyperthermia susceptibility. Clin Genet. 1996;49:186.CrossRefPubMed Fagerlund T, Ording H, Bendixen D, et al. RYR mutation G1021A (Gly341Arg) is not frequent in Danish and Swedish families with malignant hyperthermia susceptibility. Clin Genet. 1996;49:186.CrossRefPubMed
26.
Zurück zum Zitat Litman RS, Rosenberg H. Malignant hyperthermia: update on susceptibility testing. JAMA. 2005;293:2918–24.CrossRefPubMed Litman RS, Rosenberg H. Malignant hyperthermia: update on susceptibility testing. JAMA. 2005;293:2918–24.CrossRefPubMed
27.
Zurück zum Zitat Brandom BW. Genetics of malignant hyperthermia. Sci World J. 2006;6:1722–30.CrossRef Brandom BW. Genetics of malignant hyperthermia. Sci World J. 2006;6:1722–30.CrossRef
28.
Zurück zum Zitat Burke W, Pinsky LE, Press NA. Categorizing genetic tests to identify their ethical, legal, and social implications. Am J Med Genet. 2001;106:233–40.CrossRefPubMed Burke W, Pinsky LE, Press NA. Categorizing genetic tests to identify their ethical, legal, and social implications. Am J Med Genet. 2001;106:233–40.CrossRefPubMed
29.
Zurück zum Zitat Stowell KM. DNA testing for malignant hyperthermia: the reality and the dream. Anesth Analg. 2014;118:397–406.CrossRefPubMed Stowell KM. DNA testing for malignant hyperthermia: the reality and the dream. Anesth Analg. 2014;118:397–406.CrossRefPubMed
31.
Zurück zum Zitat Rosenberg H, Rueffert H. Clinical utility gene card for: malignant hyperthermia. Eur J Hum Genet. 2011;19:6. Rosenberg H, Rueffert H. Clinical utility gene card for: malignant hyperthermia. Eur J Hum Genet. 2011;19:6.
33.
Zurück zum Zitat Musselman ME, Saely S. Diagnosis and treatment of drug-induced hyperthermia. Am J Health Syst Pharm. 2013;70:34–42.CrossRefPubMed Musselman ME, Saely S. Diagnosis and treatment of drug-induced hyperthermia. Am J Health Syst Pharm. 2013;70:34–42.CrossRefPubMed
34.
Zurück zum Zitat Glahn KPE, Ellis FR, Halsall PJ, Müller CR, Snoeck MMJ, Urwyler A, et al. Recognizing and managing a malignant hyperthermia crisis: guidelines from the European Malignant Hyperthermia Group. Br J Anaesth. 2010;105:417–20.CrossRefPubMed Glahn KPE, Ellis FR, Halsall PJ, Müller CR, Snoeck MMJ, Urwyler A, et al. Recognizing and managing a malignant hyperthermia crisis: guidelines from the European Malignant Hyperthermia Group. Br J Anaesth. 2010;105:417–20.CrossRefPubMed
Metadaten
Titel
Sudden death due to malignant hyperthermia with a mutation of RYR1: autopsy, morphology and genetic analysis
verfasst von
Wenhe Li
Lin Zhang
Yue Liang
Fang Tong
Yiwu Zhou
Publikationsdatum
04.11.2017
Verlag
Springer US
Erschienen in
Forensic Science, Medicine and Pathology / Ausgabe 4/2017
Print ISSN: 1547-769X
Elektronische ISSN: 1556-2891
DOI
https://doi.org/10.1007/s12024-017-9925-y

Weitere Artikel der Ausgabe 4/2017

Forensic Science, Medicine and Pathology 4/2017 Zur Ausgabe

Neu im Fachgebiet Pathologie