Urbach-Wiethe Syndrome

A congenital lipoid storage disease with multiple tissue infiltrations producing waxiness and thickening of the skin and mucous membranes of the mouth, pharynx, larynx, and hypopharynx. It causes hoarseness and an inability to cry, often from birth. No visceral symptoms or signs are present. Associated disorders usually consist of grand mal epilepsy, attacks of rage, and mental retardation.

Cutaneomucous Proteinosis; Lipoproteinosis, Hyalinosis Cutis et Mucosae; Lipoid Proteinosis of Urbach and Wiethe; Rössle-Urbach-Wiethe Syndrome.

Genetic disorder first described in 1929 by Eric Urbach, an Austrian-American allergologist and dermatologist and Camillio Wiethe, an Austrian otologist.

Very rare; 300 cases described in the literature. This syndrome is most often seen among people of Dutch or German descent and is rather frequent in South Africa. Both sexes are affected equally. The age of onset is in infancy.

Autosomal recessive inheritance, caused by mutation in the extracellular matrix protein 1. Gene (ECM1) located on 1q21.

Not precisely known. An eosinophilic hyaline material is deposited in all affected organs. Controversy exists about the exact origin of the disease (caused primarily by lysosomal disease, abnormality of collagen metabolism, or lipid metabolism disorder).

Clinically evocated by the association of early hoarseness with an unusual skin eruption. Skin biopsy may help confirm the diagnosis (eosinophilic hyaline thickening of papillary dermal capillaries, hyperkeratosis). The hyaline material stains positively with period acid-Schiff (PAS) and is diastase resistant.

All organs can be involved: skin (hyalinosis cutis et mucosae, recurrent vesicles, bullae, and hemorrhagic crusts around mucous membranes, papules, plaques, and nodules develop on the face, axillae, and scrotum; patchy area of alopecia, generalized hyperkeratosis can be seen), mouth and pharynx (early hoarseness, papular infiltration of tongue and frenulum, teeth hypoplasia more often lateral incisors and premolars, papular infiltration of larynx and vocal cords), eyes (itchy eyes, moniliform blepharitis), and central nervous system (seizures, memory impairment, paranoia rage attacks, intracranial calcifications).

Evaluate neurological function (history, clinical, radiographs, CT/MRI, EEG) and intubation (clinical, radiographs, CT, fiberoptic).

When combined with mental retardation, the presence of occasional sudden attacks of rage can affect the preoperative period and induction of anesthesia. There is strong support for premedication and/or presence of parents for induction of anesthesia. Both direct laryngoscopy and tracheal intubation can be difficult because of larynx involvement and may require a smaller tube than predictable. Tracheal wall integrity should be assessed and spontaneous ventilation preserved until airway is secured. Catheter fixation can be difficult because of skin lesions.

Muscle relaxants should be avoided until airway is secured. Consider interaction between anticonvulsant medications and anesthetic drugs.