INTRODUCTION: Propionic acidemia is a metabolic disease produced by a deficiency of the enzyme propionyl-CoA carboxylase. It can lead to coma, with severe neurologic encephalopathy or present later in life with vomiting, hypotonia, and seizures. An early diagnosis with adequate treatment helps to prevent the sequelae. Among the described complications is optic neuropathy, although not commonly reported, it is very disabling. OBJECTIVES: To describe two patients with propionic acidemia and optic neuropathy. PATIENTS AND METHODS: Patient 1: 16 years old, male, parents without consanguinity. He was diagnosed at 5 months of age because of hypotonia and seizures. Until the age of 9 years, he evolved satisfactorily; therefore, he stopped treatment. At 13 years, he presented bilateral optic neuropathy. Patient 2: 20 years, female, parents without consanguinity. She was diagnosed with PA at 11 months of age because of hypotonia and seizures. She evolved satisfactorily until the age of 9 years when she presented a metabolic decompensation followed by a bad metabolic control. At 18 years, she presented bilateral progressive optic neuropathy. RESULTS: Both patients have psychometric scores with borderline IQ 84-75 (WISC-R) beside optic neuropathy. They were evaluated by an ophthalmologist and also by neuroimaging (MRI of optic pathway). CONCLUSIONS: Pathophysiology of optic neuropathy is not completely understood. There is evidence that the damage is due to an accumulation of neurotoxic compounds secondary to the metabolic block increasing the oxidative stress. We suggest an annual ophthalmologic evaluation in the long-term follow-up of organic acidurias with visual loss, in order to detect this disabling sequela at an earlier stage.
INTRODUCTION: Propionic acidemia is a metabolic disease produced by a deficiency of the enzyme propionyl-CoA carboxylase. It can lead to coma, with severe neurologic encephalopathy or present later in life with vomiting, hypotonia, and seizures. An early diagnosis with adequate treatment helps to prevent the sequelae. Among the described complications is optic neuropathy, although not commonly reported, it is very disabling. OBJECTIVES: To describe two patients with propionic acidemia and optic neuropathy. PATIENTS AND METHODS: Patient 1: 16 years old, male, parents without consanguinity. He was diagnosed at 5 months of age because of hypotonia and seizures. Until the age of 9 years, he evolved satisfactorily; therefore, he stopped treatment. At 13 years, he presented bilateral optic neuropathy. Patient 2: 20 years, female, parents without consanguinity. She was diagnosed with PA at 11 months of age because of hypotonia and seizures. She evolved satisfactorily until the age of 9 years when she presented a metabolic decompensation followed by a bad metabolic control. At 18 years, she presented bilateral progressive optic neuropathy. RESULTS: Both patients have psychometric scores with borderline IQ 84-75 (WISC-R) beside optic neuropathy. They were evaluated by an ophthalmologist and also by neuroimaging (MRI of optic pathway). CONCLUSIONS: Pathophysiology of optic neuropathy is not completely understood. There is evidence that the damage is due to an accumulation of neurotoxic compounds secondary to the metabolic block increasing the oxidative stress. We suggest an annual ophthalmologic evaluation in the long-term follow-up of organic acidurias with visual loss, in order to detect this disabling sequela at an earlier stage.
Authors: V Reid Sutton; Kimberly A Chapman; Andrea L Gropman; Erin MacLeod; Kathy Stagni; Marshall L Summar; Keiko Ueda; Nicholas Ah Mew; Jill Franks; Eddie Island; Dietrich Matern; Loren Peña; Brittany Smith; Tina Urv; Charles Venditti; Anupam Chakarapani Journal: Mol Genet Metab Date: 2011-09-10 Impact factor: 4.797
Authors: Marina A Schwab; Sven W Sauer; Jürgen G Okun; Leo G J Nijtmans; Richard J T Rodenburg; Lambert P van den Heuvel; Stefan Dröse; Ulrich Brandt; Georg F Hoffmann; Henk Ter Laak; Stefan Kölker; Jan A M Smeitink Journal: Biochem J Date: 2006-08-15 Impact factor: 3.857
Authors: Loren Pena; Jill Franks; Kimberly A Chapman; Andrea Gropman; Nicholas Ah Mew; Anupam Chakrapani; Eddie Island; Erin MacLeod; Dietrich Matern; Brittany Smith; Kathy Stagni; V Reid Sutton; Keiko Ueda; Tiina Urv; Charles Venditti; Gregory M Enns; Marshall L Summar Journal: Mol Genet Metab Date: 2011-09-22 Impact factor: 4.797
Authors: Zoë R Williams; P Emmett Hurley; Ugur E Altiparmak; Steven E Feldon; Georgianne L Arnold; Eric Eggenberger; Luis J Mejico Journal: Am J Ophthalmol Date: 2009-02-25 Impact factor: 5.258
Authors: Sarah C Grünert; Stephanie Müllerleile; Linda De Silva; Michael Barth; Melanie Walter; Kerstin Walter; Thomas Meissner; Martin Lindner; Regina Ensenauer; René Santer; Olaf A Bodamer; Matthias R Baumgartner; Michaela Brunner-Krainz; Daniela Karall; Claudia Haase; Ina Knerr; Thorsten Marquardt; Julia B Hennermann; Robert Steinfeld; Skadi Beblo; Hans-Georg Koch; Vassiliki Konstantopoulou; Sabine Scholl-Bürgi; Agnes van Teeffelen-Heithoff; Terttu Suormala; Wolfgang Sperl; Jan P Kraus; Andrea Superti-Furga; Karl Otfried Schwab; Jörn Oliver Sass Journal: Orphanet J Rare Dis Date: 2013-01-10 Impact factor: 4.123