Background: The Sjogren-Larsson syndrome is a rare condition characterized by ichthyosis, spasticity, and mental retardation. Patients have deficient activity of the aldehyde portion of the fatty alcohol:nicotinamide adenine denucleotide (NAD+) oxidoreductase complex. Objective: Our purpose was to describe atypical findings in three siblings with the Sjogren-Lamson syndrome and implications regarding diagnosis. Methods: Medical histories were taken and physical examinations performed on four siblings and their parents. Analysis of fibroblast fatty alcohol:NAD+ oxidoreductase or fatty aldehyde dehydrogenase activity (or of both) was determined in each. Results: Decreased fibroblast fatty alcohol:NAD+ oxidoreductase or fatty aldehyde dehydrogenase levels (or both) were present in three of four siblings. The fourth sibling and the parents had levels similar to obligate heterozygotes. None of the affected siblings fulfilled the classic criteria for the syndrome. Conclusion: Although all affected siblings had abnormally low activity of the fatty alcohol:NAD+ dehydrogenase complex, their clinical findings were variable. This divergence of clinical features in siblings has not been previously reported. We propose that deficient activity of the fatty alcohol:NAD+ dehydrogenase complex be considered part of the definition of the Sjogren-Larsson syndrome that would also include the probable, but not absolute, presence of ichthyosis, mental retardation, and spasticity.
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