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Open Access Short paper

Severe combined hyperlipidaemia and retinal lipid infiltration in a patient with Type 2 diabetes mellitus

Rachel A Davey1*, Niall C Tebbutt2, Jenny M Favaloro1, David N O'Neal2, Derek Rae3, Jeffrey D Zajac1 and James D Best2

Author Affiliations

1 Department of Medicine, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia

2 Department of Medicine, University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia

3 Department of Pathology, St Vincent's Hospital, Fitzroy, Victoria, Australia

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Lipids in Health and Disease 2006, 5:29  doi:10.1186/1476-511X-5-29

Published: 17 December 2006

Abstract

Severe combined hyperlipidaemia has occasionally been associated with infiltration of tissues in addition to arteries and the skin. We report a woman with Type 2 diabetes mellitus (DM) and severe combined hyperlipidaemia who developed retinal lipid infiltration, resulting in blindness. A 61-year-old woman with a 15-year history of Type 2 DM was admitted following a two-week history of progressive visual loss. Examination identified lipid infiltration into the retina. Phenotypically she had severe combined hyperlipidaemia with elevated IDL cholesterol and a broad beta band on lipoprotein electrophoresis, raising the possibility of familial dysbetalipoproteinaemia. However, gene sequencing analysis indicated that the patient was homozygous for the E3/E3 allele of the ApoE gene with no mutations detected in either the coding region or intron-exon boundaries. Her lipid profile improved following dietary therapy and gemfibrozil treatment, but this had little effect on either her fundal appearances or her visual acuity. Type 2 DM plays a vital role both in allowing expression of severe combined hyperlipoproteinaemia, in addition to serving as a risk factor for complications such as tissue infiltration.