First case with RANBP2 biallelic mutation and severe acute necrotizing encephalopathy phenotype

Familial acute necrotizing encephalopathy (ANE) is is a rapidly progressive encephalopathy that can occur after common viral infections at different stages of life. The clinical findings of 2 siblings diagnosed with ANE were shared and the whole-exome-sequencing study of the index case was performed. It was confirmed by the Sanger method. We found the RANBP2 gene p.I656V variant homozygous in the index case. We found the variant in the parents as heterozygous. We argue that biallelic mutations in the RANBP2 gene may result in ANE with early onset and severe prognosis by increasing penetrance. •RANBP2 can be inherited not only autosomal dominant but also autosomal recessive.•Biallelic RANBP2 gene mutations can result in increased penetrance and expressivity.•RANBP2 mutations responsible for acute necrotizing encephalopathy should be kept in mind in the post-infection encephalopathy clinic.