Alpha-mannosidosis: a diagnostic journey in patients with ultra-rare disease

Alpha-mannosidosis is a rare autosomal recessive hereditary disease characterized by lysosomal accumulation of olygosaccharides in various tissues due to deficiency of alpha-mannosidase. Low enzyme activity results from homozygous or compound heterozygous mutations of the MAN2B1 gene. Clinical manifestations of alpha-mannosidosis usually develop in childhood or adolescence and include facial deformity (Hurler-like phenotype), mental retardation, progressive sensorineural hearing loss, skeletal abnormalities, neurological and psychiatric disorders, and ocular disease. Demonstration of low activity of acid alpha-mannosidase in dried blood spots and genetic testing can be used for diagnosis. The authors present the case report of alpha-mannosidosis and discuss its pathogenesis, clinical signs and symptoms and approaches to treatment including the long-term enzyme replacement therapy with velmanasa alfa.