# A Case of 17β-Hydroxysteroid Dehydrogenase Type 10 (HSD10) Disease Caused by a Novel Variant Presenting With Rapidly Progressive Cardiomyopathy Triggered by Viral Infection

## TL;DR

A rare mitochondrial disease caused by a new genetic variant led to severe heart failure in an infant after a viral infection.

## Contribution

A novel HSD17B10 variant is reported, associated with early-onset cardiomyopathy in HSD10 disease.

## Key findings

- A neonatal case of HSD10 disease presented with early-onset cardiomyopathy triggered by viral infection.
- The novel hemizygous variant c.34G>A p.(Val12Met) was identified in the HSD17B10 gene.
- Rapid cardiac deterioration occurred despite initial metabolic improvement and normal heart function at five months.

## Abstract

Human 17β-hydroxysteroid dehydrogenase type 10 (HSD10) is a rare X-linked mitochondrial disorder caused by mutations in the HSD17B10 gene. It is typically associated with neurodegeneration and cardiomyopathy in severe cases. The neonatal form often has a poor prognosis; however, its clinical spectrum remains unclear. Herein, we present a neonatal-onset case of HSD10 disease with a previously unreported HSD17B10 variant presenting with early-onset cardiomyopathy triggered by a viral infection. A male infant presented with lactic acidosis and hypoglycemia on the first day of life. Initial treatment improved metabolic status. He was diagnosed with HSD10 disease using a targeted panel of nuclear and mitochondrial genes, which identified a novel hemizygous variant, NM_004493.3: c.34G>A p.(Val12Met). Cardiac function was normal at five months, but neurodevelopmental regression occurred at six months following vaccination. At seven months, viral myocarditis was diagnosed following rhinovirus/enterovirus infection. Echocardiography revealed a reduced left ventricular ejection fraction and ventricular dilation. Despite supportive therapy, cardiac function deteriorated, leading to death at nine months. A patient with a novel HSD17B10 variant showed early-onset cardiomyopathy in a neonatal case of HSD10 disease and rapid and fatal deterioration of cardiac function. This report highlights the importance of clarifying genotype-phenotype correlations to guide the diagnosis and management of rare mitochondrial diseases.