A Case of Corneal Dysplasia with Identification of POLH Gene Variants in Xeroderma Pigmentosum

Eun Hae Shin; Dong Hui Lim; Yoon-Duck Kim; Kyung In Woo; Jisang Han; Jong Eun Park; Tae-Young Chung; Chang-Seok Ki

doi:10.3341/jkos.2019.60.4.380

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Shin, Lim, Kim, Woo, Han, Park, Chung, and Ki: A Case of Corneal Dysplasia with Identification of POLH Gene Variants in Xeroderma Pigmentosum

Case Report

Journal of the Korean Ophthalmological Society 2019; 60(4): 380-386.

Published online: 17 April 2019

DOI: https://doi.org/10.3341/jkos.2019.60.4.380

A Case of Corneal Dysplasia with Identification of POLH Gene Variants in Xeroderma Pigmentosum

Eun Hae Shin, MD¹, Dong Hui Lim, MD^1,², Yoon-Duck Kim, MD, PhD¹, Kyung In Woo, MD, PhD¹, Jisang Han, MD³, Jong Eun Park, MD⁴, Tae-Young Chung, MD, PhD¹, Chang-Seok Ki, MD, PhD⁴

¹Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

²Department of Preventive Medicine, Graduate School, The Catholic University of Korea, Seoul, Korea.

³Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea.

⁴Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Address reprint requests to Dong Hui Lim, MD. Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel: 82-2-3410-5478, Fax: 82-2-3410-0074, ldhlse@gmail.com

Received 26 April 2018 Revised 26 June 2018 Accepted 26 March 2019

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To discuss the clinical course and diagnosis of corneal dysplasia in a xeroderma pigmentosum patient based on a genetic evaluation.

Case summary

A 42-year-old female visited our clinic for decreased left visual acuity and corneal opacity. She had undergone several surgeries previously due to the presence of basosquamous carcinoma in the left lower eyelid, neurofibroma, and malignant melanoma of the facial skin. The patient showed repeated corneal surface problems, with a suspicious dendritic lesion; however, antiviral therapy was ineffective, and herpes simplex virus polymerase chain reaction results were negative. Despite regular follow-ups, the patient showed neovascularization around the corneal limbus and an irregular corneal surface. We performed corneal debridement with autologous serum eye drops for treatment. The patient's visual acuity and corneal surface improved after the procedure. The impression cytology result was corneal dysplasia. In whole exome sequencing, two pathogenic variants and one likely pathogenic variant of the POLH gene were detected.

Conclusions

This is the first genetically identified xeroderma pigmentosum case with ophthalmological lesions of the eyelid and cornea in Korea. Debridement of the irregular corneal surface and autologous serum eye drop administration in xeroderma pigmentosum could be helpful for improving visual acuity.

Keywords: Corneal opacity, Genetically identified xeroderma pigmentosum, Limbal dysplasia, Neovascularization, POLH gene

Figures and Tables

Figure 1

Facial photos of the patient. (A) Multiple freckle-like hyperpigmented macules and cancer-suspicious skin lesions were found. (B) Left lower eyelid shows ulcerated lesion which suggested basal cell carcinoma.

Figure 2

Anterior segment photos of the patient. (A) The patient's right cornea surface was relatively smooth and clear under fluorescein staining compared with the opposite side. (B) Under scleral scatter, there was no opacity. (C) On the patient's left cornea, irregular corneal surface under fluorescein staining was found before corneal surface debridement. (D) Under scleral scatter, central and peripheral corneal subepithelial opacity was found on the left cornea. (E) After corneal surface debridement on the patient's left eye, we could see a dramatically smoothened corneal surface. (F) Although small subepithelial opacities were still present, corneal opacity was improved.

Figure 3

Impression cytology of the patient (periodic acid-Schiff [PAS] stain, ×200). The image shows limbal dysplasia exhibiting nuclear alteration with spiral-shaped or twin nuclei. Corneal epithelial cells are squamoid in shape with metachromic change in the cytoplasm and demonstrate a low nuclear-cytoplasmic ratio. There was no definite goblet cell presence.

Figure 4

Pedigree of the xeroderma pigmentosum (XP)-affected family and POLH gene mutation analysis for the proband (II-3) and proband's brother (II-1). (A) The open symbols indicate no signs or symptoms of XP. The filled symbol represents an affected individual. The half-closed symbol indicates an individual who likely has XP but who was not tested for the POLH mutation. The arrow indicates the proband (II-3). (B) Sequencing analysis identified that the patient has compound heterozygous variants c.660+2T>A and c.725C>G (p.Ser242) (arrow).

Notes

This work was supported by the National Research Foundation of Korea grant funded by the Korea government Ministry of Education (NRF-2018R1D1A1A02045884; Seoul, Korea), which was received by DHL.

^{Conflicts of Interest} The authors have no conflicts to disclose.

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