Ultrastructural examination of the axillary skin biopsy in the diagnosis of metabolic diseases

There is little information in the literature regarding the usefulness of u ltrastructural examination of axillary skin biopsies in the evaluation of m etabolic diseases. This is a retrospective clinicopathologic review of 143 patients who underwent axillary skin biopsies as part of evaluations for me tabolic disease. Twenty-three (16%) had abnormalities, classified as follow s: mitochondrial (n = 12), lysosomal (n = 6), increased glycogen (n = 3), n onspecific cytoplasmic inclusions (n = 2), ceroid lipofuscinosis (n = 1), a nd intradermal giant cells containing vacuoles and tubular inclusions (n = 1). Muscle biopsies were performed in 13 of the 23 patients; 11 showed abno rmalities, including those related to mitochondria (n = 4) and other nonspe cific changes (n = 7). Two patients underwent postmortem examination. Follo w-up was available in 21 patients. A clinical or biochemical diagnosis was reached in II patients: metachromatic leukodystrophy (n = 2), electron tran sport chain abnormalities (n = 2), glutaric aciduria type II (R = 1), Unver richt disease (n = 1), Lennox-Gastaut syndrome (n = 1), ketotic hypoglycemi a of childhood (n = 1), probable Leigh disease (n = 1), 5-methyl tetrahydro folate homocystine methyltransferase deficiency (n = 1), and pyruvate dehyd rogenase deficiency (n = 1). Of the 120 patients with negative skin biopsy results, 29 had abnormal findings on muscle (n = 27), nerve (n = 7), or bra in (n = 3) biopsies. One patient had an abnormal heart biopsy result, and 3 patients underwent postmortem examinations. Follow-up was obtained in 27 o f 29 patients. Diagnoses were achieved in 15 patients: electron transport c hain abnormalities (n = 5), cortical dysplasia (n = 3), myoclonic epilepsy (n = 1), leukodystrophy (n = 2), Pallister-Killian mosaic syndrome (n = 1), Rett syndrome (n = 1), Landau-Kleffner syndrome (n = 1), and mitochondrial cardiomyopathy (n = 1). In conclusion, axillary skin biopsy is helpful in the evaluation of some causes of metabolic disease, but often the findings are nonspecific. A negative biopsy result does not rule out the possibility of metabolic disease, but a positive result may provide direction for furt her evaluation. Copyright (C) 2001 by W.B. Saunders Company.