Child Neurology: Infantile Biotin Thiamine Responsive Basal Ganglia Disease

Biotin thiamine responsive basal ganglia disease (BTRBGD) is an inherited autosomal recessive disorder that results from the inability of thiamine to cross the blood brain barrier.^1-3 It is considered a treatable condition if vitamin supplementation, most commonly with thiamine and biotin, is initiated early.² BTRBGD can present as an infantile form, classical childhood form, or adult Wernicke-like encephalopathy.³ The infantile form is often the most severe and portends a worse prognosis with high mortality despite vitamin supplementation. We present a two-month-old who presented with irritability, opisthotonos, and abnormal eye movements who was found to have compound heterozygous variants in the SLC19A3 gene inherited in trans, including one known pathogenic intronic variant and a novel variant presumed to be pathogenic. She was therefore diagnosed with infantile BTRBGD. In this report, we discuss the differential for infantile BTRBGD, the clinical and radiologic features of BTRBGD, and describe a rapid, positive response to early vitamin supplementation in an infant with a likely pathogenic novel variant in SLC19A3.