Retinopathy and optic atrophy in a case of COQ2-related primary coenzyme Q₁₀ deficiency

ABSTRACT

Purpose

To describe a case of primary coenzyme Q₁₀ deficiency in a child manifesting as early-onset renal failure, retinal dystrophy, and optic atrophy leading to progressive vision loss.

Methods

Clinical presentation and workup including visual fields, electroretinogram, and optical coherence tomography are presented. Genetic testing was performed.

Results

An eight-year-old female with nephropathy requiring renal transplantation subsequently developed progressive cone-rod dystrophy and optic atrophy. The patient had negative results on a targeted next-generation sequencing retinal dystrophy panel but whole-exome sequencing revealed two variants in COQ2 (likely biallelic), consistent with a diagnosis of primary coenzyme Q₁₀ deficiency.

Conclusions

Primary coenzyme Q₁₀ deficiency is a rare disorder with variable systemic and ocular findings; there is also genetic heterogeneity. Genetic testing aids in the diagnosis of this condition, and variants in the COQ2 and PDSS1 genes appear to have the strongest association with ocular manifestations. Oral supplementation of coenzyme Q₁₀ may slow progression of disease. This case highlights the utility of whole-exome sequencing in the diagnosis of a rare syndromic form of ocular disease and reports a novel phenotypic association for this condition.

KEYWORDS:

• Primary coenzyme Q₁₀ deficiency
• cone-rod retinal dystrophy
• optic atrophy
• whole-exome genetic sequencing

Disclosure statement

JLD: (C): AGTC, Astellas, California Institute for Regenerative Medicine, DTx Pharma, Editas Medicine, Eloxx, Eyevensys, Foundation Fighting Blindness, Gyroscope, Helios, ProQR Therapeutics, PYC Therapeutics, Relay Therapeutics, SparingVision, Spark Therapeutics, Vedere Bio. (S): Allergan, California Institute for Regenerative Medicine, Biogen/NightstaRx, Foundation Fighting Blindness, Neurotech USA, Inc.

The following authors have no financial disclosures: JYS, DRB, AS, ATM, AGD.

Patient Consent

Written consent to publish this case has not been obtained. This report does not contain any personal identifying information.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/13816810.2022.2141792.

Additional information

Funding

This research was supported, in part, by the UCSF Vision Core shared resource of the NIH/NEI P30 EY002162, and by an unrestricted grant from Research to Prevent Blindness, New York, NY. The sources support general research efforts in the Ophthalmology department at UCSF and had no role in influencing the study design, data analysis or result interpretation.