Abstract
Type 1 Gaucher disease is a lysosomal storage disorder associated with marked phenotypic heterogeneity, including among individuals carrying genotypes historically defined as "mild". Early diagnosis, workup and follow-up care are crucial to avoid irreversible complications. We present a case series of 5 pediatric patients with type 1 Gaucher disease who had been identified based on newborn screening (NBS), parental carrier status, or clinical presentation. They were followed over time for monitoring of clinical status, hematologic indices, biomarkers including glucopsychosine, and imaging studies. Enzyme replacement therapy (ERT) was started when rising trends of biomarkers and/or new clinical symptoms appeared. Three patients were identified by NBS, one at birth due to parental carrier status, and one after symptomatic presentation with femoral fracture. All patients required initiation of ERT between 9 months and 5 years of age due to evidence of disease progression. Early diagnosis via NBS and proactive monitoring enabled timely ERT initiation in four cases, preventing irreversible organ damage and clinical complications. In contrast, the unscreened case presented with severe skeletal and hematologic involvement at baseline. Rising glucopsychosine was a sensitive early marker of disease activity and MRI was more sensitive at detecting organomegaly than ultrasound. These cases emphasize the vital importance of NBS, regular biomarker surveillance, and early intervention, even in presumed mild cases based on genotype. Early diagnosis via NBS, individualized monitoring and timely treatment are fundamental to optimizing outcomes in Gaucher disease type 1.