Vladimír Bzdúch, Darina Behúlová, Claudia Šebová, Katarína Fabriciová, Ingrid Brucknerová, Daniel Böhmer, Ivan Chalupa
Tyrosinemia type I or hepatorenal tyrosinemia is a rare autosomal recessive disorder due to the deficiency of fumarylacetoacetic hydrolase (FAH), the last enzyme in degradation of aminoacid tyrosine, with prevalence of about 1 in 120 000 newborns in general population. Tyrosinemia type I involves mainly liver, kidney and peripheral nerves. Most frequently it manifests during the first few months of life as an acute liver disease leading even to liver failure with coagulopathy and ascites. The subacute or chronic form presents with progressive liver disease and cirrhosis with high risk of developing hepatocellular carcinoma. Kidney involvement manifests typically as tubular dysfunction with hypophosphatemic rickets. The neurologic crises are not so frequent and resemble those of acute intermittent porphyria, with abdominal pain and peripheral neuropathy. The hallmark of the diagnosis of tyrosinemia type I is demonstration of elevated level of succinylacetone in urine. 2-(2-nitro- 4trifluormetyl-benzoyl)-1,3-cyklohexanedione (NTBC) treatment has distinctively improved prognosis and quality of life of tyrosinemia type I patients.