Overview Snapshot A 2-month-old boy is brought to the pediatrician by his parents due to feeding difficulties and an “enlarged” abdomen. On physical exam, there is insufficient weight gain and hepatosplenomegaly. On laboratory testing, there is a decrease in high-density lipoprotein (HDL)- cholesterol, elevated triglycerides, and an increase in LDL-cholesterol. Residual acid sphingomyelinase activity in peripheral blood leukocytes is <10% of controls. Introduction Clinical definition a lipid storage disorder due to sphingomyelinase deficiency ETIOLOGY Pathophysiology pathobiology sphingomyelinase deficiency results in the accumulation of sphingomyelin (a type of ceramide phospholipid), which deposits in the login to view 3 more bullets Genetics inheritance pattern autosomal recessive mutations chromosome login to view 1 more bullet gene login to view 1 more bullet protein encoded for login to view 1 more bullet Associated conditions medical conditions and comorbidities hepatosplenomegaly (NPD type A and B) neurodegenerative disease (NPD type A) Epidemiology Incidence rare, however in Niemann-Pick disease (NPD) type A, it is more common in the Ashkenazi Jewish population Demographics 1:1 male-to-female ratio age bracket dependent on type of NPD login to view 2 more bullets Location neural tissue (NPD type A) and visceral organs such as the spleen and liver (NPD type A and B); as well as the lung and bone marrow (NPD type B) Presentation Symptoms failure to thrive neurologic symptoms from demyelination Physical exam hepatosplenomegaly cherry red pot on macula STUDIES Labs residual acid sphingomyelinase activity is <10% of controls via peripheral blood leukocytes or cultured skin fibroblasts Histology lipid-laden macrophages ("foam cells") can be found in the liver, spleen, and bone marrow Treatment Conservative supportive care Complications Splenic rupture In patients with NPD type A, death is likely to occur by age 3 In patients with NPD type B, patients may survive into adulthood Prognosis Natural history of disease NPD type A is a fatal disease of infancy NPD type B has a more variable disease of presentation and age of onset; however, login to view 1 more bullet