Bilateral central retinal artery occlusions in an infant with hyperhomocysteinemia

Peter Karth1, Ravi Singh, Judy Kim

  • 1Medical College of Wisconsin, 925 N. 87th Street, Milwaukee, Wisconsin, USA.

Insights

A rare genetic mutation caused high homocysteine levels in a 7-week-old infant, leading to central retinal artery occlusions. This case highlights the importance of investigating hyperhomocysteinemia in young patients with atypical retinal artery occlusions.

Area of Science:

  • Ophthalmology
  • Genetics
  • Metabolic disorders

Background:

  • Retinal arterial occlusions are rare in infants and usually indicate underlying systemic issues.
  • Atypical presentations warrant a comprehensive investigation into potential metabolic and genetic causes.

Observation:

  • A previously healthy 7-week-old boy presented with bilateral central retinal artery occlusions.
  • The patient exhibited hyperhomocysteinemia and elevated serum methylmalonic acid levels.
  • Genetic analysis revealed a mutation in the transcobalamin receptor.

Findings:

  • The identified transcobalamin receptor mutation is associated with impaired vitamin B12 metabolism, leading to hyperhomocysteinemia.
  • Elevated homocysteine and methylmalonic acid levels were directly linked to the retinal artery occlusions.
  • This case establishes a novel genetic link to pediatric central retinal artery occlusions.

Implications:

  • Investigating hyperhomocysteinemia is crucial in the workup of pediatric patients with central retinal artery occlusions.
  • Early diagnosis of genetic metabolic disorders can prevent severe complications like vision loss.
  • This finding expands the understanding of genetic etiologies for retinal vascular occlusive events in neonates and infants.