{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T21:34:16Z","timestamp":1758144856710,"version":"3.44.0"},"reference-count":16,"publisher":"Walter de Gruyter GmbH","issue":"9","funder":[{"name":"MVZ Dr. Eberhard & Partner Dortmund"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_jpem-2025-0156_abs_001\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>3-Hydroxy-3-methylglutaryl-coenzyme A lyase deficiency (HMGCLD) is a rare autosomal recessive organic aciduria. Most patients present within the first year of life with metabolic decompensation, which can cause neurological damage or death if untreated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2025-0156_abs_002\">\n                  <jats:title>Case presentation<\/jats:title>\n                  <jats:p>A 20-month-old previously healthy boy was admitted to the hospital after a nocturnal seizure. Upon admission, the child was unconscious and laboratory analysis revealed severe hypoglycemia and metabolic acidosis without ketonuria. Hypoglycemia was corrected with a bolus of 10\u202f% glucose followed by continuous glucose-electrolyte infusion. Status epilepticus was treated with midazolam and phenobarbital. Magnetic resonance imaging (MRI) performed on the second hospital day, revealed bilateral and symmetric T2 hyperintense lesions in the cortex, supratentorial white matter, basal ganglia and central pons, along with slight white matter volume reduction. Urinary organic acids indicated HMGCLD. HMG-CoA lyase activity in immortalized lymphocytes was significantly decreased. Sanger sequencing of the <jats:italic>HMGCL<\/jats:italic> gene identified a heterozygous sequence variant, c.796T&gt;C, p.(Cys266Arg). MLPA analysis showed a reduced gene dosage for exons 3 and 4 of <jats:italic>HMGCL<\/jats:italic>, consistent with a heterozygous deletion. Upon diagnosis, a low-protein diet was recommended, as well as oral <jats:sc>l<\/jats:sc>-carnitine therapy with a high-calorie supplement drink at night. Initially, the child had slightly impaired psychomotor development, which normalized by age 3.5. He was without metabolic crises or seizures since diagnosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2025-0156_abs_003\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In any child presenting with hypoketotic hypoglycemia and metabolic acidosis of unknown etiology, HMGCLD should be considered. Given the rarity of HMGCLD and its sporadic cases across Europe, management should involve a well-experienced multidisciplinary\u00a0team.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/jpem-2025-0156","type":"journal-article","created":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T18:29:22Z","timestamp":1749839362000},"page":"996-1000","source":"Crossref","is-referenced-by-count":0,"title":["3-Hydroxy-3-methylglutaryl-coenzyme A lyase deficiency: case report of a child with rare HMGCL gene variants"],"prefix":"10.1515","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1702-0270","authenticated-orcid":false,"given":"Milena","family":"Bjelica","sequence":"first","affiliation":[{"name":"Institute for Child and Youth Health Care of Vojvodina , Novi Sad , Serbia"},{"name":"University of Novi Sad, Faculty of Medicine , Novi Sad , Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0851-325X","authenticated-orcid":false,"given":"Aleksandra","family":"Stojadinovi\u0107","sequence":"additional","affiliation":[{"name":"Institute for Child and Youth Health Care of Vojvodina , Novi Sad , Serbia"},{"name":"University of Novi Sad, Faculty of Medicine , Novi Sad , Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3375-5069","authenticated-orcid":false,"given":"Marija","family":"Kne\u017eevi\u0107 Pogan\u010dev","sequence":"additional","affiliation":[{"name":"Institute for Child and Youth Health Care of Vojvodina , Novi Sad , Serbia"},{"name":"University of Novi Sad, Faculty of Medicine , Novi Sad , Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4575-0051","authenticated-orcid":false,"given":"Katarina","family":"Kopriv\u0161ek","sequence":"additional","affiliation":[{"name":"Institute for Child and Youth Health Care of Vojvodina , Novi Sad , Serbia"},{"name":"University of Novi Sad, Faculty of Medicine , Novi Sad , Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2903-4872","authenticated-orcid":false,"given":"J\u04e7rn Oliver","family":"Sass","sequence":"additional","affiliation":[{"name":"Inborn Errors of Metabolism, Department of Natural Sciences , Bonn-Rhein-Sieg University of Applied Sciences , Rheinbach , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5986-0468","authenticated-orcid":false,"given":"Sarah C.","family":"Gr\u00fcnert","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics, Adolescent Medicine and Neonatology , Medical Center\u2013University of Freiburg, Faculty of Medicine , Freiburg , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Falko","family":"W\u00fcnsche","sequence":"additional","affiliation":[{"name":"MVZ Dr. Eberhard & Partner Dortmund , Dortmund , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raina","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"MVZ Dr. Eberhard & Partner Dortmund , Dortmund , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2025,6,13]]},"reference":[{"key":"2025091715550569898_j_jpem-2025-0156_ref_001","doi-asserted-by":"crossref","unstructured":"Sass, JO. 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