Download PDF
Journal of Pediatric Neurology 2016; 14(02): 089-092
DOI: 10.1055/s-0036-1583273
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Infantile Refsum Disease: A Rare Case

Rafat J. Sayed
1   Department of Pediatric Neurosciences, Bai Jerbai Wadia Hospital, Parel, Mumbai, Maharashtra, India
,
Shilpa D. Kulkarni
1   Department of Pediatric Neurosciences, Bai Jerbai Wadia Hospital, Parel, Mumbai, Maharashtra, India
,
Varsha A. Patil
1   Department of Pediatric Neurosciences, Bai Jerbai Wadia Hospital, Parel, Mumbai, Maharashtra, India
,
Meenal Garg
1   Department of Pediatric Neurosciences, Bai Jerbai Wadia Hospital, Parel, Mumbai, Maharashtra, India
› Author Affiliations
Further Information

Publication History

17 March 2015

18 May 2015

Publication Date:
28 April 2016 (online)

    Permissions and Reprints

Abstract

Peroxisomal biogenesis disorders are a group of rare genetic disorders due to impairment in one or more peroxisomal function. Infantile Refsum disease (IRD) is a peroxisomal biogenesis disorder caused by a defect in phytanic acid metabolism. We report the case of a 6-year-old boy who presented with developmental delay, ataxia, hypotonia, areflexia, vision and hearing impairment, dysmorphism, and hepatomegaly. His plasma very long chain fatty acids analysis revealed increased levels of phytanic acid, pristanic acid, and higher ratios of C24/22 and C26/22 than the normal. This confirmed the diagnosis of IRD in our case. Magnetic resonance imaging revealed progressive white matter changes involving cerebral white matter, cerebellar white matter, and dentate nuclei of the cerebellum, along with progressive corticocerebellar atrophy which have been infrequently described in the literature. Owing to the rarity of cases of IRD being reported especially from India, and the peculiar imaging findings, we wish to report this case.

Keywords

infantile Refsum disease - peroxisomal biogenesis disorders - white matter changes

Note

All authors have read the article and approved the final version. R. S., V. P.: Data acquisition. S. K., R. S., V. P.: Literature research, article preparation. S. K., V. P., R. S., M. G.: Article editing and revision.


 

  • References

  • 1 Aubourg P, Wanders R. Peroxisomal disorders. Handb Clin Neurol 2013; 113: 1593-1609
    PubMedGoogle Scholar
  • 2 Smith SA, Ouvrier R. Peripheral neuropathies. In: Swaiman KF, Ashwal S, Ferriero DM, eds. Pediatric Neurology: Principles and Practice. 4th ed. Vol 2. Philadelphia, PA: Elsevier; 2006: 1887-1918
    Google Scholar
  • 3 Steinberg SJ, Dodt G, Raymond GV, Braverman NE, Moser AB, Moser HW. Peroxisome biogenesis disorders. Biochim Biophys Acta 2006; 1763 (12) 1733-1748
    CrossrefPubMedGoogle Scholar
  • 4 Refsum S, Salomonsen L, Skatvedt M. Heredopathia atactica polyneuritiformis in children. J Pediatr 1949; 35 (3) 335-343
    CrossrefPubMedGoogle Scholar
  • 5 Ogier H, Aicardi J. Metabolic diseases. In: Aicardi J, ed. Diseases of the Nervous System in Childhood. 2nd ed. London: Mackeith Press; 1998: 258-264
    Google Scholar
  • 6 Torvik A, Torp S, Kase BF, Ek J, Skjeldal O, Stokke O. Infantile Refsum's disease: a generalized peroxisomal disorder. Case report with postmortem examination. J Neurol Sci 1988; 85 (1) 39-53
    CrossrefPubMedGoogle Scholar
  • 7 Dubois J, Sebag G, Argyropoulou M, Brunelle F. MR findings in infantile Refsum disease: case report of two family members. AJNR Am J Neuroradiol 1991; 12 (6) 1159-1160
    PubMedGoogle Scholar
  • 8 Choksi V, Hoeffner E, Karaarslan E, Yalcinkaya C, Cakirer S. Infantile refsum disease: case report. AJNR Am J Neuroradiol 2003; 24 (10) 2082-2084
    PubMedGoogle Scholar
  • 9 Cakirer S, Savas MR. Infantile Refsum disease: serial evaluation with MRI. Pediatr Radiol 2005; 35 (2) 212-215
    CrossrefPubMedGoogle Scholar