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Sometimes when you hear hoof beats, it could be a zebra: consider the diagnosis of Fabry disease

James O Burton1*, John P Dormer2, Helen E Binns3 and Warren P Pickering4

Author Affiliations

1 Department of Infection, Immunity & Inflammation, School of Medicine and Biological Sciences, University of Leicester, Leicester, LE1 9HN, UK

2 Department of Histopathology, University Hospitals of Leicester NHS Trust, Leicester, UK

3 Department of Cardiology, Northampton General Hospital, Northampton, UK

4 Department of Nephrology, Northampton General Hospital, Northampton, UK

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BMC Nephrology 2012, 13:73  doi:10.1186/1471-2369-13-73

Published: 31 July 2012



Fabry disease is an X-linked lysosomal storage disorder that results from a deficiency of the enzyme α-galactosidase A. Fabry disease is present in 4–5% of men with unexplained left ventricular hypertrophy or cryptogenic stroke. As enzyme replacement therapy is now more widely available, it is important to recognise the signs and symptoms of the disease and establish the diagnosis so that early treatment can be started before irreversible organ damage occurs.

Case Presentation

A previously fit and well 32-year-old Caucasian male presented with multisystem dysfunction including renal impairment. Although he had no suggestive symptoms, a diagnosis of Fabry disease was first established on a native renal biopsy. This was confirmed by enzymatic testing and subsequent genetic analysis that revealed a potentially new pathogenic variant.


This case highlights the importance both of Fabry disease as a differential diagnosis in patients with renal impairment in the context of multi-system disease and also of adequate tissue sampling for electron microscopy when performing native renal biopsies.

Anderson-Fabry disease; Renal biopsy; Zebra bodies; Multi-system disease