VARS2 and metabolic acidosis: We see a certain similarity in the case of a patient with pathogenic VARS2 mutations c.643C>T (p.His215Tyr) and c.1354A>G (p.Met452Val) who presented with poor sucking at birth, poor motor activity, hyporeflexia, hypertonia, persistent pulmonary hypertension of the newborn (PPHN), metabolic acidosis, severe lactic acidosis, and hypertrophic cardiomyopathy (12).