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A 5-year-old boy with a history of global developmental delay was diagnosed with influenza A per his PCP and presented to a local hospital ED with five days of lethargy, poor PO intake, decreased urine output, and fever. He was transferred to the closest specialty pediatric hospital where an MRI revealed decreased signal in the basal ganglia, and an EEG showed slowing consistent with metabolic versus infectious encephalopathy. A genetic work-up noted significant heteroplasmy for mutation of the m.3243A>G MT-ATP6 gene, which is associated with MELAS (mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes) syndrome.

Educational objectives:

Upon completion of this activity, participants should be able to:

  • Identify the most common early presenting symptom associated with MELAS
  • Differentiate nutritional supplements for which there is evidence to use in treatment of MELAS
  • Describe the biochemical pathophysiology that contributes to multi-organ dysfunction in MELAS


Drs. Sinha, Kremm, and Robbins report no relationships with third party entities producing health care goods and services.

All presenters disclosure of relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients is listed above.  No other planners, members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships to disclose.

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.05) continuing education units (CEU) which are equivalent to .5 contact hour.

For your credit transcript, please access our website 4 weeks post-completion at and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

This course has been expired.