• Yun Wang, Weimin Zhang, and Xuandong Jiang.
• Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, P.R. China.
• Medicine (Baltimore). 2023 Nov 24; 102 (47): e36008e36008.

RationaleMitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a subset of rare mitochondrial diseases characterized by diverse clinical manifestations, which often complicates its diagnosis.Patient ConcernsThis report chronicles the experiences of a 14-year-old female patient who underwent multiple misdiagnoses before the eventual identification of MELAS syndrome. Her journey began with symptoms that included growth retardation, hypertrophic cardiomyopathy, and epilepsy.DiagnosisThe definitive diagnosis of MELAS syndrome was established through genetic confirmation, revealing a mutation in the MT-TL1 gene (m.3242A > G).InterventionsUpon diagnosis, the patient received targeted symptomatic treatment, which led to pronounced improvements in her symptoms.OutcomesThe patient's condition stabilized with the administered treatments, and she exhibited significant symptom relief, emphasizing the importance of accurate diagnosis and timely intervention.LessonsThis case underscores the imperative for heightened clinical vigilance and thorough differential diagnosis in the face of complex clinical presentations, such as those seen in MELAS syndrome, to ensure timely and appropriate interventions.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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