A 10-day-old neonate is admitted to the NICU from the Emerge…
A 10-day-old neonate is admitted to the NICU from the Emergency room, with parental complaints of lethargy and decreased breastfeeding for last 2 days. Physical examination findings were notable for several papules on the scalp and lower back, lethargy, and a bulging fontanel. Laboratory results demonstrate hypoglycemia, metabolic and lactic acidosis, respiratory alkalosis, normal plasma ammonia, and elevated amino acid levels in plasma and urine. The most likely etiology for these findings is:
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