Glucose-6-Phosphate Dehydrogenase Deficiency Presented with Convulsion: A Rare Case
A 70-year-old female patient presented to the emergency department of Akdeniz University Medical Faculty Hospital (Turkey) with a complaint of fatigue. The patient had generalized tonicclonic seizures while she was in the emergency department; but spontaneously regressed in the follow-up. In the physical examination, the patient had no hepatosplenomegaly, peripheral lymphadenopathy, and there were no signs of jaundice.\nDuring the follow-up, she was oriented and cooperative. Her body temperature was 36.8 degrees Celsius. The patient’s brain MRI (magnetic resonance imaging) and diffusion MRI of the brain showed normal findings. The patient’s laboratory findings were as follows: hemoglobin: 8.5 g/dL (12-16 g/dL), number of red blood cells: 2.5 million/mm3 (4-6), LDH: 685 U/L (135-214 U/L), direct bilirubin: 0.45 mg/dL (0-0.2 mg/dL), total bilirubin: 6.67 mg/dL (0.1-1.2 mg/dL), reticulocytes 4.5% (0.5-1.5), creatinine: 0.7 mg/dL (0.7-1.2 mg/dL), platelets: 344,000/microliter (150,000-450,000/microliter), sodium: 140 mEq/L (136-145 mEq/L), potassium: 4.2 mEq/L 3.5-5.1 mEq/L), albumin 4.2 g/dL (3.9-4.9 g/dL), and calcium: 9.8 mg/dL (8.4-10.2 mg/dL). Normochromic-normocytic erythrocytes were present in the peripheral blood smear, while no atypical cells and blasts were present. There was no visible schistocytes and fragmentation. Negative direct Coombs and negative indirect Coombs tests were noted. The patient’s other laboratory findings were within normal ranges. The patient was hospitalized to find the etiology of her symptoms and 2 units erythrocyte suspension was given to the patient. The clinical electroencephalography was evaluated as normal, and as the patient had no seizure recurrence, her convulsion episodes were associated with acute symptomatic anemia by the department of neurology.\nThe hemoglobin electrophoresis test of the patient showed normal results. The patient’s hemoglobin level increased to 11.6 g/dL after transfusion but decreased again to 7.5 g/dL immediately in two days. The patient’s history revealed recent ingestion of broad beans two days prior to attending the emergency service. The blood test results showed low levels of glucose-6-phosphate dehydrogenase (G6PD), which was 1.7 IU/g Hb (4-10) and which was measured after transfusion. After 72 hours (the third day), 2 units of erythrocyte suspension was given again to the patient and the patient’s hemoglobin level increased to 10.9 with decreased bilirubin levels (direct bilirubin: 0.19 mg/dL; total bilirubin: 0.48 mg/dL); therefore, the patient was discharged with improved symptoms. She was followed-up in hematology outpatient clinic. The patient’s glucose-6-phosphate dehydrogenase level was checked during her hematology outpatient follow-up and the level was found 3.4 IU/g Hb (4-10) with a normal reticulocyte count of 1.37% (0.5-1.5).