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The earliest symptoms include cramping and stiffness of muscles leading to muscle weakness affecting the arms and legs

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J Pediatr 93:235238 Labay V, Raz T, Baron D, Mandel H, Williams H, Barrett T, Szargel R, McDonald L, Shalata A, Nosaka K, et al (1999) Mutations in SLC19A2 cause thiamine-responsive megaloblastic anaemia associated with diabetes mellitus and deafness