Hypervalinemia is a rare autosomal recessive metabolic disorder in which urinary and serum levels of the branched-chain amino acid valine are elevated, without related elevation of the branched-chain amino acids leucine and isoleucine. It is caused by a deficiency of the enzyme valine transaminase. Presentation
Presenting in infancy, symptoms include lack of appetite, vomiting, dehydration, hypotonia and failure to thrive. Genetics
Hypervalinemia is inherited in an autosomal recessive manner. This means the defective gene responsible for the disorder is located on an autosome, and two copies of the defective gene (one inherited from each parent) are required in order to be born with the disorder. The parents of an individual with an autosomal recessive disorder both carry one copy of the defective gene, but usually do not experience any signs or symptoms of the disorder. Diagnosis
See also
Isovaleric acidemia
Maple syrup urine disease
Propionic acidemia

References


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Eczema vaccinatum is a rare severe adverse reaction to smallpox vaccination. It is characterized by serious local or disseminated, umbilicated, vesicular, crusting skin rashes in the face, neck, chest, abdomen, upper limbs and hands, caused by widespread infection of the skin in people with previous diagnosed skin conditions such as eczema or atopic dermatitis, even if the conditions are not active at the time. Other signs and symptoms include fever and facial and supraglottic edema. The condition may be fatal if severe and left untreated. Survivors are likely to have some scarring (pockmarks). Smallpox vaccine should not be given to patients with a history of eczema. Because of the danger of transmission of vaccinia, it also should not be given to people in close contact with anyone who has active eczema and who has not been vaccinated. People with other skin diseases (such as atopic dermatitis, burns, impetigo, or herpes zoster) also have an increased risk of contracting eczema vaccinatum and should not be vaccinated against smallpox. Presentation
Associations
Eczema is also associated with increased complications related to other vesiculating viruses such as chickenpox; this is called eczema herpeticum. Diagnosis
A culture of vesicular fluid will grow vaccinia virus. Skin biopsy shows necrotic epidermal cells with intranuclear inclusions. Treatment
Eczema vaccinatum is a serious medical condition that requires immediate and intensive medical care. Therapy has been  supportive, such as antibiotics, fluid replacement, antipyretics and analgesics, skin healing, etc. ; vaccinia immune globulin (VIG) could be very useful but supplies may be deficient as of 2006.